Sample Appeal Letter Format
The sample letter given below will demonstrate how an appeal letter should be written.
Name
Street Address
City, State, Zip Code
Date MM/DD/YYY
Dear Claims Review Department.
I am writing to you about a claim sent by [ Medical provider] on behalf of [patient]. On [date], the charges were entered and the amount totaled to [Amount]. [Healthcare provider] has denied the payment for this procedure mentioning that the health agency was not licensed while the procedure was conducted.
The state of [Name of the state] does not require a home health agency to have a license. The home health agency visits are also covered under my insurance plan. Thus i would like you to reconsider the decision of refusal to pay for this procedure. A written documentation which supports my position is attached to this letter.
Please do reconsider the denial. If more information is required, please do inform so that i can supply you with it.
Thank you
[Signature of the Insured Client]
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Posted by Amit Bhawani on Jul.23, 2009, under Sample Letters
