How to Write an Appeal Letter When Not Medically Necessary

Health insurances companies have the right to approve or deny medical claims and procedures based on medical necessity. A review board at your health insurance company will review any claims that you or your medical provider submit to determine if they will be covered. Your health insurance company can also deny services that require pre-authorization such as a surgical procedure. If your insurance company denies a claim or procedure, you have the option of filing an appeal -- even if your procedure or treatment is not considered medically necessary. This is done by writing a letter.

Things You'll Need

• Computer
• Paper
• Denial letter

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Instructions

• 1

  Identify yourself. Include your name, date of birth, insurance ID number, group number and the effective date of your insurance plan. You should also include the subscriber's name. The subscriber is the person who the insurance is through. This can be yourself, a spouse or a parent.

• 2

  Briefly summarize why your insurance company denied your claim.

• 3

  Describe the medical condition you are being treated for or are attempting to seek treatment for.

• 4

  Explain why you believe the decision to deny was wrong. If you believe an error was made, such as the insurance company did not have all the facts, then say so. If you believe the procedure is necessary, explain why and how you will benefit from the treatment. Even if the treatment is not medical necessary at this time, explain the long-term effects of not treating your condition now.

• 5

  Explain the actions you would like to see taken; that is, the reversal of the denied claim.

• 6

  Include a letter from your doctor. Ask your doctor to write a explain why the procedure or treatment is necessary. You can also include the office notes from a recent visit with your doctor that discuss his findings and potential treatment outcomes.