Enrollment Exception 5 Appeal Letter Free Download


Enrollment Exception 5

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Appeal Letter Displayed for Your Convenience


Health Symphony Appeal Letter

For Enrollment Exception

Your name and address

Date

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.

Option 1: (Group Policy) I understand that there is a specified timeframe in which to enroll my newborn to my plan’s coverage and we had every intention of complying with this requirement to obtain coverage. However, we were not notified by our employer that this needed to be done. In addition, we informed our employer of our pending delivery and they should have advised us of this policy requirement or provided us with the necessary documents to sign to extend coverage to our newborn.

Option 2: (Individual Policy) I understand that there is a specified timeframe in which to enroll my newborn to my plan’s coverage and we had every intention of complying with this requirement to obtain coverage. However, we were not notified by our health plan that this needed to be done. In addition, we informed our health plan of our pending delivery by having this procedure pre-authorized and they should have advised us of this policy requirement or provided us with the necessary documents to sign to extend coverage to our newborn.

We respectfully request that you take this information into consideration and extend us an exception to this policy requirement. We are prepared to pay for any additional premiums to add our newborn for coverage to prior months.

Thank you for your time and consideration.

Sincerely,

[Insured’s Name]

Enclosures:

Statement of medical illness from your physician on your behalf