Download "Pre-existing Coverage Appeal " Word Document
Appeal Letter Displayed for Your Convenience
Health Symphony Appeal Letter
For A Pre-existing Coverage Denial
Your name and address
Address of Plan Review Department
Dear Review Department:
I have received a denial on a request for coverage on your plan with the explanation that it was being denied due to a preexisting condition.
The denial letter 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 me for coverage], 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 request for coverage.
Thank you for your time and assistance, and I look forward to your prompt response.
Listing of physicians seen, upon request
Physician’s statement of no current treatment