Sample Letter For Appealing An Insurance Claim Denied For A Specific Procedure

Bankrate has a good example letter you can use if your health insurance company denies your claim for based on a specific medical procedure. 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 insurance company must not been properly informed with the full information, and requires getting additional specialist letter(s) testifying to its necessity, as well as including articles about the procedure. There’s no guarantee of its success, but it can at least serve as an initial salvo before escalating your issue elsewhere.

Form letter for denial of specific medical procedure [Bankrate]


Edit Your Comment

  1. peggynature says:

    Oh. When you said “Madlibs” style, I was hoping they’d have places for adjectives. Then you could describe your ailment and the treatment quite adequately like, “I was diagnosed with GNARLY HEMMORHOIDS in August 2007. I believe I will significantly benefit from AWESOME ANUS SURGERY.”

    But that’s just me…I loved Madlibs as a child. Perhaps too much.

  2. warf0x0r says:

    @peggynature: ROFL

  3. Bryan Price says:

    What I most enjoy are the letters that I get from my old insurance company telling me that they’re denying this claim or that claim. I’m just now finding this out from two years ago?

    Florida law is weird, if the provider doesn’t provide you with a bill 90 days after the incident, they can’t go after you for the money. (At least that’s what my wife, a 16 year resident here tells me.) I went to a dermatologist for a check over (I had some things that I wasn’t sure what they were – nothing it turns out) and that’s what the insurance decided to decline. That or the doctor decided to rebill it.

    Funny, at the same time I did that, I received a statement from my periodontist. According to that, I was on the hook for over $10k of work that had been done. Turns out that was what they were waiting for the insurance to pay, and I shouldn’t have seen the statement, I owed zero. How much of that was an insurance write-off I don’t know.

    If somebody would ever come up with an article on insurance write-offs for doctors, I know I’d be fascinated by it. I saw a bill for some time I had spent in a hospital, and from what the insurance paid (HMO at the time) and what I paid, it was about 10% of what they were originally billing. They (and I) were basically paying for a set rate per day, regardless of what tests that they ran.