How to Write a Successful Appeal Letter for a Denied Medical Claim
- Limine Martine
- May 26, 2023
- 1 min read
Updated: Jun 7, 2023
When a patient’s insurance company denies a medical procedure or refuses to pay for an approved test, treatment or surgical procedure, it can be devastating. Luckily, patients have the right to appeal the decision. But how do they do it? And what exactly should be included in an insurance appeal letter?
The truth is that it’s not uncommon for insurance companies to deny medical claims. And for healthcare facilities, denials can add up quickly and put an organization at a huge disadvantage financially.
Typically, the first step in the process of appealing a claim denial is to submit an internal appeal with the insurance provider. If the denial is still not overturned after an internal review, the next step is to request an external appeal with a third party that is not affiliated with the insurance provider.
It’s important to know that every insurance plan is different and that each policy has a unique set of instructions for how to appeal a claim denial. You should always check your health insurance provider’s website for information on how to file an appeal, and be sure to follow those instructions precisely.
When it comes to writing an appeal letter, it’s vital to include a reason why the insurance company should reconsider the denial. This may include information about why the treatment is medically necessary, such as a previous diagnosis that supports its necessity or a recommendation from your physician that it should be provided. It could also involve explaining why the insurance company should cover a service that has been pre-approved.
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