Download "Wrong Member Number Appeal Letter" Word Document
Appeal Letter Displayed for Your Convenience
Health Symphony Appeal Letter
For Wrong Member Number
Your name and address
Address of Claims review department
RE: Name of Insured:
Plan ID #:
Dear Claims Review Department:
I am writing to you in regards to a claim submitted by [Medical Provider] for [patient]. The charges were rendered on [Date] and totaled [Claim dollar total]. [Health Plan] has denied payment on these charges.
The claim was denied because it had my incorrect member/subscriber number. My correct member/subscriber number is [enter number]. I have provided a copy of my insurance card for confirmation.
Please reconsider this claim and pay the appropriate benefits to the medical provider. If you require additional information or have questions, please contact my medical provider directly at [phone number].
Thank you for your time and consideration.
By request, additional information from the medical provider
Billing information of the claim sent originally, including billed date