Denied Claim Appeal Letter

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Medical claims can be denied for a wide variety of reasons, but when you believe a reason is not justified you can send a denied claim appeal letter to your insurance company. Medical bills can be very expensive; therefore you do not want to pay anything out of pocket that should be covered by your insurance carrier. As a policy holder, you do have the right to challenge denials made by your insurance company.

Format and Content

There is some basic information that should be included in a denied claim appeal letter format. Your insurance group, policy and claim numbers should be in the letter along with your name, the date of your procedure, the name of your healthcare provider and the reason the insurance company gave for not paying the claim. Most patients and providers are notified of a denial with a letter from the insurance company or an explanation of benefits.

Sample

Tests like a PET scan (positron emission tomography) which produces 3-dimensional images of organs deep in the body and magnetic resonance imaging which produces more 2-dimensional images of organs and tissues just under the skin can be expensive. This denied claim appeal letter sample is from a patient whose insurance company denied payment on a PET scan stating that a less expensive MRI would have been sufficient to diagnosis the patient’s medical problem.