Bankrate has a good example letter you can use if your health insurance company denies your claim for being out of network. It’s in “Madlibs” style, so you’ll need to replace all the items in red with your personal information. The argument is based on the premise that the out-of-network provider is the only one within a reasonable distance who can effectively perform the procedure you need. There’s no guarantee of its success, but it can at least serve as an initial salvo before escalating your issue elsewhere.
Sample Letter For Appealing Claims Denial Based On Out Of Network Benefits
By September 18, 2007