Health Insurance Appeal Letter and How to Write it

After going through several medical treatments, it is surely upsetting to find out that your claim is denied by the health insurance companies. If this is happening, the patient can object the decision and write the health insurance appeal letter. In writing the letter, there are a number of things that you need to remember. However, before we talk about that, let’s look at some reasons why health insurance companies deny the patients’ claim to pay for the treatment.


The Reasons why Your Claim Gets Denied

There are a lot of reasons why health insurance companies reject to pay for something. Before you are submitting the health insurance appeal letter, here are some of the common reasons that you need to know.

Treatment Urgency

Health insurance companies may disagree with the treatment that the patients received. If it is found that the treatment is not urgent or it is urgent, but the patients fail to ensure the insurer, the chance is the insurer will not pay for the treatment.

The Treatment is not Covered

Another common reason is because the treatment is not covered by the insurance plan.  Sometimes, the patients miss the information by not checking thoroughly about the treatments covered by the insurance.

What to Write in Health Insurance Appeal Letter

When you are sure about your decision in writing a health insurance appeal letter, first you need to make the situation clear by explaining to the insurer as detail as possible. Include the facts and attach some documents needed such as the medical records and the physician’s statement. The intention is to get the health insurance companies pay your treatment, so you need to tell the truth and avoid exaggerating the condition. At the end of the letter, thank for the consideration. It is a simple gesture but it will be appreciated.

Sample of Health Insurance Appeal Letter

Below is a sample of appeal letter sent by the patient to explain her condition so that hermedical claim gets reconsidered by the insurer.

Dear Mr. Bobby,

I am writing this letter as a response of the Health Care Insurance’s denial towards my medical treatment coverage for the cosmetic surgery that I received on July 15, 2018. Please accept this my appeal letter. As I have read in your denial letter, the main reason to deny the treatment is because the cosmetic surgery is not covered in my insurance plan. I believe there is a mistake in the misinformation here.

I changed the insurance plan in your company started from last month. In the current insurance plan that I am paying right now, there is a coverage for cosmetic surgery. I have the letter proof that I did the upgrade plan, which I attach along with this letter. As an insurance member in your company for several years, there may have been a information mishap in the data since this is the first time I upgrade my insurance plan. Aside, the doctor told me that the surgery is needed as I have difficulty in breathing if I do not receive the surgery soon. It was because of the nose bridge problem that I have since I was born. This is another reason of why I decided to upgrade my insurance plan.

I believe the documents I attach can be as a consideration to grant my medical claim. Dr. Jacob, who performed my surgery, has agreed for further confirmation if it is needed by the insurance company. Thank you for the consideration.



Brenda George

This is one example as how the health insurance appeal letter is written. You can modify based on the situation that you have. Hopefully it helps.


You may also like...