Download "Enrollment Exception 2 Appeal Letter" Word Document
Appeal Letter Displayed for Your Convenience
Health Symphony Appeal Letter
For Enrollment Exception
Your name and address
Address of Claims review department
RE: Name of Insured:
Plan ID #:
Dear Claims Review Department:
I am writing to you in regards to a claim submitted by [Medical Provider] for [patient]. The charges were rendered on [Date] and totaled [Claim dollar total]. [Health Plan] has denied payment for this medical procedure stating that [patient name] was not eligible under this plan and therefore no benefits were payable.
I understand that there is a specified timeframe in which to enroll my newborn to my plan’s coverage and I had every intention to comply with this requirement. However, as I am no longer employed at the workplace from which I obtain this insurance as I am on COBRA, I was not notified to add my child as a dependent from my previous employer.
After doing research on this issue, I have found that most health plans allow automatic coverage during the child’s first 30 days after birth.
I respectfully request that you take this information into consideration and extend me an exception to this policy requirement. I am prepared, with the assistance of my physician, to provide any necessary documentation to support this statement.
Thank you for your time and consideration.