Enrollment Exception 2 Appeal Letter Free Download

Enrollment Exception 2

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 #:
Claim #:

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.


[Insured’s Name]