Download "Timely Filing Error Appeal Letter" Word Document
Appeal Letter Displayed for Your Convenience
Health Symphony Appeal Letter
For Timely Filing
[CITY, STATE, ZIP]
[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