Wrong Plan Billed Appeal Letter Free Download


Wrong Plan Billed

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Health Symphony Appeal Letter For Wrong Health Plan Billed 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. I provided a copy of my insurance card and completed the Registration Form indicating the name and type of insurance I hold at the time I received medical treatment. Unfortunately, my medical provider (name the physician or hospital facility) billed the wrong health plan. Due to this error, my health plan (name the health plan), is denying my claim because it was not submitted in a timely manner. However, please consider that I did provide my correct insurance information at the time of service and though it did not reach the proper health plan, it was billed on time. I feel I should not be penalized for this administrative mistake. 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