How to Write an Insurance Appeal

Your life can be turned upside down if you are denied coverage for a medical procedure or treatment. Many times, an insurance company denial occurs after the treatment has already taken place, leaving you with a stack of bills that are impossible to pay.



In this case an appeal is needed. Part of the appeal process is writing an appeal letter. Write a solid appeal letter by gathering all the pertinent documents related to your case and then stating the reasons you feel the insurance company should pay your claim.

Things You'll Need

• Medical records
• A letter from your doctor
• Medical journal excerpts

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Instructions

• 1

  Obtain all medical records about your specific procedure or treatment from your doctor's office.

• 2

  Acquire a letter from your doctor explaining the specifics of your case, why he prescribed the procedure or treatment, and the effects the treatment has had on your health.

• 3

  Gather articles from expert medical journals (your doctor may help you with this) explaining the validity of the procedure or treatment you underwent.

• 4

  Include your insurance information (policy number, group number, and claim number) in your letter and the reason your claim was denied as stated by the insurance company.

• 5

  Include a detailed history of your illness, dates of your doctor visits, and how the decision to try your procedure or treatment was reached.

• 6

  Explain in a pleasant, professional tone why you believe the decision to deny you coverage was incorrect. Be as specific as possible, citing the reasons you have gathered from your medical records, doctor's letter, and medical journal findings.

• 7

  Weave into your final argument other pertinent information (taken from your doctor's letter or medical articles) which support your doctor's decision. Provide examples where your specific procedure or treatment helped others as well as the success rate.

• 8

  In your final paragraph, state that you would like the insurance company to reverse the denial and afford you the coverage you believe you deserve.