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Health Symphony Appeal Letter

Follow Up Appeal

Your name and address

Date

Address of Claims review department

RE: Name of Insured:
Plan ID #:
Claim #:

Dear Claims Review Department:

On [date of first letter], I appealed a denied claim for [name of insured person]. A copy of that claim and appeal letter is enclosed.

I would like to take this opportunity to follow up with you on my original appeal. As of yet, I have not heard from you [or the claim remains denied; or give other reason here]. For this reason, I am attaching another copy of my original appeal.

If I do not hear from you promptly, I will have no alternative but to seek other options. I believe I have received medically necessary and appropriate care and it should be covered by my health plan.

I hope to hear from you soon.

Sincerely,

[Insured Name]

Enclosures:
A statement of medical necessity from your medical provider if requested
A copy of original appeal letter