How to Write an Appeal to the Insurance Company

You may be treated for an illness and be denied coverage by your insurance company. When this happens, the first step is to work with your doctor on an alternative treatment. However, appealing the decision is something that insurance companies accept. Part of the appeals process involves writing a letter that needs to provide all pertinent information showing you were wrongly denied. Fortunately, you can get some help organizing all this from your local clinic.

Instructions

Getting Prepared

• 1

  Make copies of all the documents or letters the insurance company sent you explaining why they turned you down for coverage. Copy any correspondence you wrote in reply.

• 2

  Talk to the local clinic that’s treating you for your illness and tell them you plan to appeal a decision by your insurance company. Work with a case manager that the clinic will usually assign you. Case managers help you get things organized.

• 3

  Ask the case manager for specific documents that prove your medical diagnosis, including any from the clinic files or even articles from prestigious medical journals that indicate how serious your illness may be.

• 4

  Request that your doctor or specialist write an appeal letter that they will send themselves. While they may know the procedures for writing it, request that it include information about your illness, the particular treatment you’ll be getting and why you need to have the treatment. You can create your own appeal letter to accompany this.

Your Own Appeal Letter

• 5

  Start the letter by including all your insurance information at the top left of the page. Include your policy number and all other pertinent insurance numbers that identifies your case. State in the opening paragraph the reasons the insurance company gave for why they denied you so you can emphasize the denial.

• 6

  Prove the denial was wrong by stating facts you found in the medical journal articles. Provide any information that shows the insurance company was perhaps in error. On rare occasions, an insurance company may enter the wrong code number.

• 7

  Write exactly why you think the insurance company’s denial was wrong and what the health and financial circumstances would be if they don’t cover the treatment for you. Cite once again evidence from medical journals you’ve found that back up your assertions.

• 8

  Finalize the letter by requesting what you want the insurance company to do, as in covering your procedure. Go into specifics of what you want them to do if it involves more detail within a larger treatment plan. Cancer treatments, for instance, have various categorical procedures that insurance may or may not cover. Tell the insurance company you want the approval quickly and not have it drag on for weeks or months.

Sending and Waiting for an Appeal

• 9

  Include your letter and all the evidential documents you have into a package and mail to the insurance company. Send the package registered mail so the insurance company can’t say they never received your appeal.

• 10

  Check your policy to see what the wait time is for a response.

• 11

  Contact the insurance company if you haven’t heard a response within that required time. Ask them when you may get a reply. Most reputable insurance companies will give you an answer.