Download "Pre-Existing Condition Appeal Letter" Word Document
Appeal Letter Displayed for Your Convenience
Health Symphony Appeal Letter
For A Pre-existing Denial
Your name and address
Address of Claims review department
RE: Name of Insured:
Plan ID #:
Dear Claims Review Department:
I have received a denial on claims submitted on my behalf with the explanation that it was being denied due to a preexisting condition.
The EOB (explanation of benefits) I received did not provide me with a clear and concise justification as to how [Health Plan] arrived at this decision. In order for me to more specifically understand your justification for your decision, please provide me with the following information:
The name and credentials of the insurance representative who made the decision to not approve my claim, an outline of the records reviewed and any other information used to support your decision.
Upon receipt of your written justification of your decision, I will furnish a listing of all the physicians I have seen in the past [policy requirement of the number of years] to prove that I have not been seen, treated or diagnosed for any illness or injury prior to my seeing this physician related to the claim that was submitted on my behalf.
Thank you for your time and assistance, and I look forward to your prompt response.
Listing of physicians seen, upon request