Health Insurance Appeal Letter

Health Insurance Appeal Letter

April 23, 2050

Jeremy Marvin

ApTerra

Omaha, NE 68101

Dear Mr. Marvin,

I am writing to formally appeal the denial of benefits under the above-referenced health insurance policy for my recent medical treatment. I received a denial notice dated April 15, 2050, which states that my claim for physical therapy sessions was denied due to lack of medical necessity.

I believe this decision was made in error and would like to provide additional information and supporting evidence to substantiate my claim. Below, I have outlined the reasons why the denied claim should be reconsidered:

  1. Medically Necessary: My treating physician, Dr. Macey Erdman, has determined that the physical therapy sessions are medically necessary for my condition, chronic lower back pain. Enclosed with this letter is a detailed statement from Dr. Macey Erdman, indicating the medical necessity and benefits of the treatment.

  2. Policy Coverage: According to the terms outlined in my health insurance policy, the treatment falls within the scope of covered services. I have attached excerpts from the policy that highlight the relevant coverage sections.

  3. Previous Authorization: Before receiving the treatment, I obtained the necessary pre-authorization from your company. Attached is a copy of the pre-authorization letter issued by Pros Factory.

Additionally, I have included the following documents to support my appeal:

  • A copy of the denial notice

  • A letter of medical necessity from Dr. Macey Erdman

  • Relevant medical records and test results

  • Policy excerpts indicating coverage

  • Pre-authorization letter

Given this compelling evidence, I respectfully request that you reconsider your decision and approve my claim for the physical therapy sessions. This treatment is critical for managing my condition and improving my quality of life.

Please inform me of your decision in writing at your earliest convenience. Should you require any further information or need to discuss this appeal in more detail, I am available at 222 555 7777 or via email at [Your Email].

Thank you for your time and attention to this matter. I look forward to a favorable resolution.

Sincerely,

[Your Name]


Letter Templates @ Template.net