Download "Physician’s Assistant Appeal " Word Document
Appeal Letter Displayed for Your Convenience
Health Symphony Appeal Letter For Physician’s Assistant Denial 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 on these charges because [Health Plan] has indicated that you do not pay for services provided by a physician’s assistant. I have been advised that the physician’s assistant routinely provides the same medical services as the primary care physician and is well qualified for these duties. Please find enclosed his/her State Board of Medical Examiners’ license. Based on this information, I believe that the services which were rendered are medically necessary and should be fully reimbursed. Furthermore, the utilization of a physician assistant under the guidance and direction of a physician is a cost effective format for extending these services. [Health Plan] did not quote any limitation or exclusion from the policy in reference to physician’s assistants. Please reconsider this claim and pay the appropriate benefit. Thank you for your time and consideration. Sincerely, [Insured’s Name] Enclosures: Copy of the Physician’s Assistant’s Medical Examiner’s License Any additional information supporting your case, including, but not limited to, the language within the policy booklet, or lack thereof, regarding physician assistants.