Timely Filing 3 Appeal Letter Free Download


Timely Filing 3

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Appeal Letter Displayed for Your Convenience


Health Symphony Appeal Letter

For Timely Filing

[NAME]

[ADDRESS]

[CITY, STATE, ZIP]

[Date]

[Health Plan]

[Address]

[City, State, Zip]

Subscriber No: [Number]

Patient Name: [name]

To Whom It May Concern:

Enclosed are claims that were submitted to you, but they have not been paid as of this date. The charges were rendered on [Date of Service] and totaled [Claim dollar total]. [Health Plan] has denied payment on these charges because [Health Plan] has indicated that these claims were not processed due to their failure to meet the applicable timely claim filing requirement.

I provided the medical provider with an updated copy of my insurance card, once I was notified of my insurance eligibility. {add additional information as to the reason why the claim was not billed on time}. My physician provided medically necessary services. In consideration for the services rendered, I am seeking reimbursement from your office. I am requesting that you reconsider your denial of this claim and process the claim for payment.

If you have any questions, please do not hesitate to contact me at (---) --- ----. Your cooperation is anticipated and greatly appreciated.

If you have any questions please do not hesitate to contact me at [phone number].

Sincerely,

[Name]

Your name and address

Enclosures: None