How to Write an Appeal Letter for Medical Insurance

Kyle Walton

7 years ago

“To sum it up…”

You will understand the reasons why you may have to write a repeal letter
Knowing how to write an appeal letter is important and the steps will assist you, so the process is less stressful
Doctors and specialists often will write a letter of appeal for you as they have your medical records as well as the rejection of payment information.
Understanding how to formulate a repeal letter may seem taxing. However, samples and advice are accessible

Human error occurs. It is accidental and often is missed by checks and balances. It is why examining your insurance policies and knowing what your insurer will cover and what they will not is imperative to avoid rejection. But, again, medical coders may enter a code incorrectly, or you may not have finished your end of the claim.

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Missing Information

Missing information comes from different directions. Sometimes it is you that has not provided your insurer with all the information they require to pay the claim. Other times, it is the doctor or specialist who does not send all the necessary paperwork.

In the case of missing information, you may want to call your insurance company and question as to whether you can remedy the situation from your end or if further action is needed. If it comes down to a letter of appeal, missing information can easily be obtained, approved, and the claim paid in full.

Examine Your Denial Letter

Read and reread your denial of claim letter. Your insurance company will list the reasons of claim refusal. The information is pertinent and often you can remedy the situation yourself.

Your Health History

Often, doctors and specialists accidentally lose paperwork or forget to send it with their claim on your insurance policy. When you call your agent or write your repeal letter, lay out your illness, health issues, and any future fears of catastrophic events. The step requires your doctor to assist by releasing your medical records, so your insurance agency has the full picture.

Correct Your Information

When you read the letter of refusal of payment, it may be as simple as you correcting information through your health insurance company.

If the issue is in regards to your medical records, calling your doctors or specialists to fix their end also elevates the stress of having a claim denied.

Uncovered Treatments

Some procedures do not fall under every insurance policy. It is important for you to know your health insurance plan from the inside out so that you do not fall into the pitfall of not knowing your insurance does not cover a procedure.

You can do nothing about the situation other than pay the claim yourself. It is good practice to make sure your treatments have coverage before the treatment.

Unessesary Treatment

Unnecessary procedures do not fall under the umbrella of health insurance. The types include plastic surgery or weight loss procedures. If you know without a doubt that your insurance will not cover the health strategy, writing an appeals letter is useless.

Writing Your Appeal Letter

The appeal process is easy if you take it one step at a time. In most cases, you will want to write a letter to send to your insurance company even if you are not entirely sure it will work.

You will receive a letter of denial to pay a health insurance claim. The letter will have the information as to why it falls under claim rejection will be within the letter’s content.

Your health insurance policy should be transparent and read in its entirety by you. Every insurance company has a different policy and procedure in regards to appeals. Your health insurance policy should have a clause that specifically points you towards how to go about an appeal.

While slowly composing the repeal letter one step at a time, consult with your physicians as they can add to your rebuttal of denial of the claim.

Your doctors have direct access to your records and the health insurance claim. In many cases, they will directly work with your insurance company and a letter may not be required.

You may still find yourself in a stressful situation and the refusal to pay the claim. It is now that you need to write a letter of appeal. The information you have gathered from the letter from your insurance company, your policy, and your health records will assist you in formulating your message with facts.

Make yourself clear in your letter. State why you believe they are wrong in not paying the healthcare claim. Write your letter in such a way that it includes every reason you think the claim is legitimate. Be clear, concise, and professional, because money paid for coverage makes it the epitome of consumer rights.

Make copies of everything you sent to your insurance company. It includes the records you referred to in your repeal letter, but also the letter itself. You are your health advocate, and by keeping copies, you are ensuring your records are in order.

Reaching a Claim Settlement

Once you are clear with what you want and need from your insurance company, keep in constant contact with your agent for the final decision. Follow-up continuously until you have closure in the situation that is in agreement with all parties involved.

You will receive a letter of either approval or an explanation about the claim’s denial. Add it to your records that you are keeping.

You are the owner of the health insurance policy. It is your right to write appeal letters and question your agent about your health insurance plan. Do not give up if you know you are on the right side of the policy.

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