Sample "Appeal Letter for Insurance Claim Denial"

An Appeal Letter for Insurance Claim Denial is a document that individuals can use when they would like to request their insurance company to review the denial of their insurance claim. The purpose of the document is to persuade the insurance company to take into account the evidence that has been provided with the appeal letter and reassess the decision they made. Commonly, this kind of appeal letters are prepared by patients and is supported by their doctors. If you have never compiled an appeal letter before, you can check out our sample Letter for Appealing a Health Insurance Claim Denial that can be downloaded below.

Generally, there are certain types of things that must be included in your letter:

  1. Personal Details. It is necessary to state your personal information in your appeal letter (which can include your contact details, insurance policy details, etc.).
  2. Reference to the Denial Letter of the Insurance Company. You can also refer to the letter of the insurance company that they used to notify you about the denial of your insurance claim.
  3. Information About a Doctor. Your appeal letter should be supported by a doctor, whose contact information should be provided here.

Still looking for a particular sample? Take a look at the related samples and templates below:

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Sample Appeal Letter for Insurance Claim Denial
From: Sarah Johnson
4829 Vernon Street
Denver, Colorado 43839
+1 594-434-3593
[Date]
To: ABC Insurance
483 Beechwood Avenue
Denver, Colorado 32593
To Whom It May Concern,
I am writing on behalf of Ann Rice to appeal your decision to deny reimbursement for the
ultrasound sought by Mrs. Rice on July 16, 2021.
It is our understanding that ABC Insurance is denying coverage on the basis that it is "not
medically necessary." We believe that the ultrasound is medically necessary in Mrs.
Rice’s case and that her treatment is a covered plan benefit.
Attached you’ll find the letter from Mrs. Rice’s doctor describing:
● Why he found it medically necessary to perform the ultrasound;
● The recommendation of why she should have this ultrasound.
● A recent article explaining that ultrasounds for situations like hers (high enzyme
count in the liver) are standard-practice.
Thank you for your immediate attention to this matter.
Sincerely,
Sarah Johnson
[Signature]
©
TEMPLATEROLLER.COM
Sample Appeal Letter for Insurance Claim Denial
From: Sarah Johnson
4829 Vernon Street
Denver, Colorado 43839
+1 594-434-3593
[Date]
To: ABC Insurance
483 Beechwood Avenue
Denver, Colorado 32593
To Whom It May Concern,
I am writing on behalf of Ann Rice to appeal your decision to deny reimbursement for the
ultrasound sought by Mrs. Rice on July 16, 2021.
It is our understanding that ABC Insurance is denying coverage on the basis that it is "not
medically necessary." We believe that the ultrasound is medically necessary in Mrs.
Rice’s case and that her treatment is a covered plan benefit.
Attached you’ll find the letter from Mrs. Rice’s doctor describing:
● Why he found it medically necessary to perform the ultrasound;
● The recommendation of why she should have this ultrasound.
● A recent article explaining that ultrasounds for situations like hers (high enzyme
count in the liver) are standard-practice.
Thank you for your immediate attention to this matter.
Sincerely,
Sarah Johnson
[Signature]
©
TEMPLATEROLLER.COM