An individual writes an appeal letter to an insurance company when they disagree with the company’s decision on not covering a procedure. The individual will address their reasons in why they believe the company should be paying for a certain practice. This letter must have a firm tone and clearly state their arguments with facts.

 

The main aspects to cover in an appeal letter are:

  • Your identification, which can be a policy number, a claim number, or a group number that aids in identifying your case.
  • A history of your particular problem, like your illness if you are claiming health insurance.
  • The correct information and why you think the decision they made is wrong; search for facts to state why your argument is right.
  • State what the company should do for your case, so that you can ask them to cover the procedure with your stated facts.

 

Sample appeal letter to an insurance company:

 

October 15, 2016

 

Homer Reynolds

Red Cross Red Shield Insurance Company

6754 Cross Street

New York, NY 10024

 

Re: Jane Smith

Medical Coverage – Y7654870012894451GA

(Group number/Policy Number)

 

Dear Homer,

Please accept this letter from me as an appeal to the company – Red Cross Red Shield, for denying the coverage of my laparoscopy procedure. I received a letter of refusal on June 25, 2016, saying that the insurance company does not cover procedures that use any form of laser technology.

As you know, I was diagnosed with gall bladder stones on February 15, 2016. I have recently had a baby and I cannot undergo another surgery due to my high blood pressure. Please see the enclosed letter from my doctor, Dr. Devi, who explains my medical condition and history in more detail. Dr. Devi is from the NY Medical Center and is the head specialist.

I believe that my details were not as explained to you when you decided to refuse my insurance. I am also sending my medical records with this letter to help you see why I need this procedure carried out.

I request your company reconsider my situation and allow the procedure be covered through insurance. My treatment has to take place on December 5, 2016. If you require any further information, please contact me at 677-630-8976. I look forward to hearing from you on this matter shortly.

 

Sincerely,

Jane Smith