Because each individual case is unique with its own facts and details, no form letter is likely to result in a satisfactory appeal. However, we have included sample letters to demonstrate successful arguments in typical appeals. In most cases, these letters resulted in successful appeals! It is important to follow the appeal steps outlined in the patient’s policy.
Helpful Information to Include in a Letter:
- Date/Nature of the insurance denial
- Description of the medical and treatment history of your patient.
- Brief description of your patient’s efforts at securing appropriate care.
- See "Common Reasons for Insurance Denials" for common denials and sample responses and resources to educate insurance providers.
With guidance, patients/families are often able to provide written summaries of their history and efforts to secure appropriate care to facilitate the letter-writing by their health care providers.