Because your individual story is unique with its own facts and details, no form letter is likely to result in a satisfactory appeal. However, we have included sample letters to demonstrate successful arguments in typical appeals. In most cases, these letters rsulted in successful appeals! It is important to follow the appeal steps outlined in the patient’s policy.
Helpful Information to Include in a Letter:
- Date/Nature of the insurance denial
- Description of the medical and treatment history of your family member (you can get this information from the medical records, and/or from direct communication with the treating physician)
- Name and contact information for the treating physician (you may also want to indicate if the physician has expressed willingness to be contacted by the insurer)
- See "Common Reasons for Insurance Denials" for common denials and sample responses and resources to educate insurance providers.