Free Claim Denial Letter Layout Template
Claim Denial Letter Layout
[Your Company Name]
[Your Company Address]
[Your Company Number]
[Your Company Email]
[Date]
[Claimant’s Name]
[Claimant’s Address]
[City, State, ZIP Code]
[Policy Number/Claim Number]
Dear [Claimant’s Name],
We are writing to inform you that your recent medical claim submitted on [Claim Submission Date] has been reviewed and, unfortunately, denied.
Reason for Denial:
After careful consideration, we regret to inform you that your claim has been denied due to [specific reason for denial]. This decision is based on the following [policy provision/contractual terms/coverage limits]: [provide detailed explanation].
Supporting Information:
[Here, you may include any specific documentation or evidence that supports the denial of the claim. For example: “The treatment in question was not covered under the terms of your policy because it falls outside of the covered services.”]
Next Steps and Appeal Instructions:
If you disagree with this decision, you have the right to appeal. To initiate an appeal, please follow these steps:
-
Submit a written appeal to [Appeal Submission Address or Email].
-
Include all relevant documentation that supports your case.
-
Request a review by a different representative if you believe additional information or clarification is needed.
For further assistance or to discuss your claim, please contact our customer service department at [Your Company Number] or [Your Company Email].
We understand that this may be disappointing news, and we are here to assist you with any questions you may have. Thank you for your attention to this matter.
Sincerely,
[Your Name]
[Your Title]
[Your Company Name]
