Write Your Own Appeal Letter

When writing an appeal letter, please consider several things.  Here are some of them:

Clearly state the problem

  1. In your appeal letter, clearly indicate what you are appealing and provide specifics of when the medical service occurred.  You should consider using the exact wording the health plan used when describing the denial.  
  2. When the health plan considered your claim, on their explanation of benefits, they may have used a claim number.  Include the claim number on the claim so that they could identify your claim quickly.

Give an explanation why the denial should be overturned

  1. You should read your policy booklet and use their own language to overturn your denial if they made an obvious mistake.

  2. Consider a strategy with your appeal.  Your appeal letter should have a specific point of view.    

Clearly state your proposed resolution

  1. In the body of your appeal letter, ask for your specific resolution.  This may include to reconsider the claim for full payment within a certain time frame, usually 30-45 days.    

  2. Also explain what may occur if your health plan does not reconsider the claim, such as contacting your State Department of Insurance or an attorney.

See what a sample appeal letter looks like.  (click here)

Final Words:

It is interesting to note that when processing a claim, there may be a 7 - 10% error rate by the health plan, so some claims denials may be clearly evident.  For the rest of them, it will be more difficult to appeal.  However, everyone should always appeal a claim denial as the success rate is in the 40-50% range, depending on how well the letter is written.  

Health Symphony has decades of experience in writing an effective appeal letter.  If you would like to purchase an appeal letter to save you time and effort, then click here.

Appeals Resources


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