Lack of Medical Necessity Hospital was Paid Appeal Letter Free Download


Lack of Medical Necessity Hospital was Paid

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Health Symphony Appeal Letter

For Lack of Medical Necessity (Hospital was Paid)

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 it was not a covered service.

The facility [Facility Name] had their charges authorized and each DOS was paid for. The authorization number is [Auth #]. There stands no reason why the professional charges should not be paid. A patient is unable to obtain facility charges without the request and rendering of professional services during the hospital stay.

In order to properly evaluate your decision, please provide me with the name and credentials of the insurance representative who made the decision to not pay for this medical procedure, an outline of the records reviewed and any other information used to support your decision.

Additionally, I have included a statement of medical necessity from the attending physician who is also prepared to provide a rebuttal to your decision once you have provided me with the requested information.

Thank you for your time and consideration.

Sincerely,

[Insured’s Name]

Enclosures:

Statement of medical necessity from the medical provider