Medical Insurance Appeal Letter

[Your Name]
Madison, WI 53701
222 555 7777
[Your Email]

September 17, 2065

Health Insurance Company
Claims Department
Madison, WI 53701

Subject: Appeal of Denied Claim – Claim Number 789456

Dear Claims Department,

I am writing to formally appeal the denial of my recent claim for a surgical procedure submitted under policy number 112233. The claim was denied on September 10, 2065, based on the reason that the procedure is deemed not covered under my plan.

I believe this claim was denied in error and would like to provide additional information for reconsideration. The procedure in question is a laparoscopic cholecystectomy, which was performed on August 15, 2065, by Dr. Tom Walter at Invogorance Surgical Center.

This procedure was deemed medically necessary by Dr. Walter due to my ongoing issues with gallstones and related complications, which were documented in the attached medical records.

Enclosed are copies of the following documents to support my appeal:

• The detailed medical report from Dr. Tom Walter

• The invoice from Invogorance Surgical Center

• My previous correspondence with your customer service team

• The policy coverage document highlighting that the procedure should be covered

These documents demonstrate that the procedure was necessary and falls under the coverage provisions outlined in my policy. I kindly request a review of this information and a reconsideration of the claim.

Please contact me at 222 555 7777 or via email at [Your Email] if any additional information is required.

Thank you for your prompt attention to this matter. I look forward to your favorable response.

Sincerely,

[Your Name]

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