If you are dealing with a denied health insurance claim and you cannot come to an agreement with your insurer by phone, a written appeal is the next step. To be successful, or even to be considered, your letter of appeal must adhere to your provider's rules. How you present your case can also have a big impact on whether your claim is accepted.
Instructions
1. Check you insurance policy for the appeals procedure. Your policy should detail the information you need to include in any written appeal, the deadline for submitting appeals after a claim has been denied, the address to which you should send your appeal letter and any rules for how the appeal should be mailed. Each insurance provider has their own specific standards for handling appeals, but if you cannot find this information in your policy, request a written copy of the appeal rules before you write your letter. You will need to stick to them exactly, so a written copy will help you make sure you don't miss a step.
2. Gather the information required for the appeal. Check your policy for the exact information you need, but generally speaking, expect to need the claim number, your policy number, date of disputed treatment and the name of your doctor/medical provider. If possible, get a statement from your doctor saying that the treatment was medically necessary and any other evidence that supports the medical necessity of your treatment, including medical records and lab reports.
3. Write the letter. In addition to including all of the required information, explain your claim and why you believe that the denial was issued in error. Request that the insurance company reconsider the claim. Even if it seems apparent why you are writing, spell everything out specifically, including exactly what you want the insurance company to do.
4. Mail your letter. Your insurance company may require that letters of appeal be sent by certified mail, but even if they don't, consider sending it certified anyway. Certified mail will give you proof that you mailed the letter before the deadline for appeals expired should your letter get lost at the insurance company.
