Download "Newborn Notification Denial Appeal " Word Document
Appeal Letter Displayed for Your Convenience
Health Symphony Appeal Letter
Appeal Newborn Notification Denial
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 it was not a covered benefit as [patient] is not an eligible dependent under my plan.
On [Specific Date], I called and spoke with [Contact Person] and asked about benefits for [the medical procedure] for [patient]. I was told that this procedure was a covered service, but the Health Plan’s representative did at no time advise me that we had to register [patient] with my health plan within 31 days of birth. The representative not only told me that it was a covered service, but also assured me that it would be paid.
I feel that I should not be penalized for receiving incomplete information from your benefits department. As a member who pays monthly premiums for my health plan, I expect that you would protect my interests and notify me of any potential problem in coverage that requires my action. I never received a notification in the mail or was advised by my employer regarding newborn notification, even though you were aware of my wife’s pregnancy and covered these expenses entirely.
As a member of [health plan] I am requesting your reconsideration of this denial and extend the coverage for my child. If there is any additional information I could provide to you that would expedite this matter, please feel free to contact me. Thank you for your time and assistance in this matter.
A notation with the date, time and person spoke with when calling for benefit information.