{"id":55893,"date":"2022-12-13T09:30:58","date_gmt":"2022-12-13T14:30:58","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=55893"},"modified":"2024-10-25T11:00:58","modified_gmt":"2024-10-25T15:00:58","slug":"insurance-appeal-letter","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/insurance-appeal-letter\/","title":{"rendered":"How to write a health insurance appeal letter"},"content":{"rendered":"

Imagine you need to get an MRI. You’ve had unexplained headaches with no discernable trigger, and your provider wants additional tests to rule out anything serious. So, you get a referral from your healthcare provider, make an appointment, and then wait until the scheduled day. Meanwhile, the radiologist’s office contacts your insurance to get the service approved. The day before your appointment, you get a call. Your insurance provider decided to deny the claim, which means you can’t have the scan. Or, worst-case scenario, you’ve already gotten it and your insurance denied the claim after the fact. Meaning, they won’t cover the cost.<\/span><\/p>\n

Your insurance company may have had the right to deny your claim, sure. But you have the right to know why they denied it. Legally, your insurance company must let you know exactly why your claim was denied or why they terminated your insurance coverage (if they did). They’re also required to tell you that you can appeal their decision. And you should, by writing a health insurance appeal letter.<\/span><\/p>\n

What is an insurance appeal letter?<\/span><\/h2>\n

A letter of appeal to an insurance company is what you send to your insurance provider when they’ve denied a claim or ended your coverage. It’s your opportunity to disagree with whatever they’ve decided, and the company will then have to go through a review process to make sure everything was handled fairly and according to the law. You’re essentially asking them to reconsider their decision. This is something you can send, or your provider can appeal on a patient’s behalf as well.<\/span><\/p>\n

“If your health plan denies coverage for a treatment, test, service, or surgery, it is important to note that you do have the option to challenge this, which is called an appeal,” says Ben Aiken, MD, a family physician at <\/span>Lantern Health<\/span><\/a> and the VP of Health at insurance administrator <\/span>Decent<\/span><\/a>. “If your appeal is successful, then you may receive coverage for the service by the insurance company.”<\/span><\/p>\n

How to write an insurance appeal letter<\/span><\/h2>\n

Here’s how to write an appeal letter to your insurance company.<\/span><\/p>\n

Before you send the letter<\/span><\/h3>\n

There are <\/span>two types of health insurance appeals<\/span><\/a> — the first step is deciding which one is appropriate for your case.<\/span><\/p>\n