Free Medical Appeal Letter Template
Medical Appeal Letter
[Your Name]
Mesa, AZ 85201
[Your Email]
222 555 7777
Allene Tillman
Claims Review Specialist
Nethival Insurance
Tampa, FL 33601
September 17, 2050
Subject: Appeal for Denied Coverage of Physical Therapy – Claim Number 384922
Dear Ms. Tillman,
I am writing to formally appeal the denial of coverage for my prescribed physical therapy sessions under Claim Number 384922, which was denied on August 30, 2050. After reviewing the denial notice, I believe that the decision to deny coverage was made in error based on the medical necessity and details of my policy.
The denial letter stated that the physical therapy sessions were not covered because they were deemed “not medically necessary.” However, my physician, Dr. Amelia Pagac, has confirmed that these therapy sessions are crucial for my recovery from the knee surgery I underwent on June 15, 2050. Without physical therapy, I risk prolonged recovery time and possible complications, as outlined in the attached medical documentation.
The attached documents include:
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Medical Records: Comprehensive records from Dr. Pagac and Tampa General Hospital outlining the necessity of physical therapy for my recovery from knee surgery.
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Bills/Invoices: Detailed invoices for the physical therapy sessions from Tampa Physical Therapy, totaling $3,500.
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Letter from Healthcare Provider: A letter from Dr. Pagac, dated July 20, 2050, affirming the need for physical therapy as part of the post-surgery treatment plan, according to standard medical practices.
Based on the provided documentation, I respectfully request that you review this information and reconsider the denial of coverage. These therapy sessions are medically necessary to restore mobility and prevent further health issues, and they should be covered under the terms of my policy with Nethival Insurance.
I appreciate your prompt attention to this matter and look forward to a favorable resolution. Please feel free to contact me at 222 555 7777 or [Your Email] if further information is required.
Thank you for your time and consideration.
Sincerely,
[Your Name]
