How to Write an Insurance Appeal Letter?
Insurance appeals letters are appeal letters written to an insurance company by a claimant appealing to the insurance provider to review an earlier decision to deny a claim. Let’s break it down. Imagine that you signed an insurance contract with an insurance company to provide a health plan for your family in the event of any health care-related challenges.
Let’s assume you had a minor work-related accident and since this accident is within the scope of your health care insurance contract, you go to your insurer claiming costs for treatment for costs accrued during the treatment period. Unfortunately, your insurance provider refuses to pay the health care costs for one reason or the other.
An appeal letter is what you write to explain to your health care provider why they should bear your treatment costs as per the terms and conditions of the health coverage insurance you acquired for your family.
In simpler terms, a letter of appeal is a written appeal to your insurance provider to review a denied insurance reimbursement.
How to Write an Appeal Letter?
Writing insurance appeal letters is as simple as writing a regular formal letter to your boss. You just have to make sure that some important details are provided, and you’re good to go. Let’s discuss what you need to keep in mind while writing your appeal letter to your insurance provider:
- Ensure that your name, policy number, address, phone number, date your claim was denied, the official that attended to you, and any other information you think would be necessary for proper review and resolution of the problem.
- Be detail-oriented. While you’re writing an official letter, which should essentially go straight to the point. It should not be at the expense of details. Your letter should be explanatory, include all the details of occurrences until that point, and explain why you think the denial was in error.
- Patience. You need to be patient with your insurance company. Give them a reasonable time to resolve the issue and if they fail, you can always request an external appeal.
Below is a letter of appeal sample to guide you when writing one.
Sample letter to an Insurance company
[Insurance Company Name]
[City, State ZIP]
[Type of Coverage]
Dear [Name of contact person at insurance company],.
My name is ——— and I’m a policyholder in your company. I wish to file an appeal concerning your company’s denial of a claim for [ claim denied]. I received an explanation of benefits dated [date] stating that [provide reasons for denial].
[Narrate details of events and explain why you think the denial was in error]
Kindly review these details as provided and reconsider your decision to allow coverage for the claim. Thank you for your anticipated consideration to this appeal
Responding to a denial letter can be extremely frustrating, especially when this denial has to do with the need for urgent medical care. Feel free to send an appeal in response to the denial letter proving that you are within your rights to seek your insurance based on earlier agreements.
Still confused? Contact an attorney to help guide you through this process today.