Printable Insurance Appeal Letter

[YOUR NAME]
Phoenix, AZ 85001
[YOUR EMAIL]

IdeaMate
Las Vegas, NV 89101

October 9, 2050

Subject: Appeal for Denied Medical Claim – #128398

Dear Jewell Ward,

I hope this letter finds you well. I am writing to formally appeal the denial of my recent medical claim, reference number #128398, which was submitted on September 15, 2050. The claim was denied on October 1, 2050, citing that the service rendered was not covered under my policy.

As a policyholder, I believe that this denial warrants reconsideration due to the following reasons:

1. Service Description: The claim pertains to a necessary surgical procedure performed on September 10, 2050. The treatment was essential for my health condition, as documented by my healthcare provider.

2. Supporting Documentation: Enclosed with this letter, you will find supporting documents, including:

   • A detailed report from Dr. Lawrence Orn, outlining the medical necessity of the procedure.

   • Invoices and receipts for the services rendered.

   • Any additional relevant medical records.

3. Policy Coverage: According to my insurance policy, I believe that these services fall under covered benefits as stated in Section 4.2: Surgical Procedures.

Given this information, I kindly request that you review my claim again, taking into account the attached documentation and the necessity of the medical service provided. I appreciate your attention to this matter and look forward to your prompt response.

If you have any questions or require further information, please do not hesitate to contact me at 222 555 7777 or via email at [YOUR EMAIL].

Thank you for your assistance in resolving this issue.

Sincerely,

[YOUR NAME]

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