Wrong Member Number Appeal Letter Free Download


Wrong Member Number

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

Date

Address of Claims review department

RE: Name of Insured:
Plan ID #:
Claim #:

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.

Sincerely,

[Insured’s Name]

Enclosures:

None
By request, additional information from the medical provider

Billing information of the claim sent originally, including billed date