Timely Filing Error Appeal Letter Free Download

Timely Filing Error

Download "Timely Filing Error Appeal Letter" Word Document

Appeal Letter Displayed for Your Convenience

Health Symphony Appeal Letter

For Timely Filing





[Health Plan]


[City, State, Zip]

Subscriber No: [Number]

Patient Name: [name]

To Whom It May Concern:

I am writing to you in regards to a claim submitted by [Medical Provider] for [patient]. The charges were rendered on [Date of Service] and totaled [Claim dollar total]. [Health Plan] has denied payment for 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 had applied for eligibility through my employer, but unfortunately I was not notified of my coverage until later. If I had known that I was eligible at the time of service, I would have provided this to [Medical Provider] without hesitation. I am requesting a one time exception for [Health Plan] to pay this claim as I am an eligible subscriber of the plan and feel I should not be penalized for someone else’s error.

This is a claim for a medically necessary service and 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 and consideration is anticipated and greatly appreciated.



Your name and address

Enclosures: None