How To Write An Insurance Appeal Letter


In the United States, medical procedures and special medications can be denied by the patient’s insurance company. The good news is that a denial by the insurance company is not the end of the process. Most, if not all, insurance companies allow their clients to submit an appeal letter explaining why the medication or procedure is vital to their long-term health. An appeal letter does not always sway an insurance company, but these types of letters have been known to work in the past.

Advice For Writing An Appeal Letter

It is important to be respectful when writing an appeal letter and put your disappointment aside. The insurance company is obviously comfortable with its decision, so you trying to unleash your anger on the company is not going to make things any better. The insurance company more than likely made its decision based on finances. Your approach to an appeal letter should be practical, respectful and unemotional.

Identify Yourself

The opening of your appeal letter should offer all of your identification including your name, address, phone number, policy number and case number for the procedure you are writing about. You should include all of the names of the doctors involved, and you should also have a timeline in place to show exactly when everything regarding this case occurred.

A Summary Of The Denial

The next paragraph quickly outlines the procedure you had requested and the reason it was declined. While it is true that the insurance company has that information on file, you significantly increase your chances of overturning your denial if you do all of the research work for the company in your appeal letter.

A Summary Of Your Condition

Your next paragraph will go into detail about the treatment history of your condition and any medications you have taken so far. Your doctor can help you to piece together the accurate history from your diagnosis to present day, and you should ask your doctor to help you with as much medical detail as possible.

Your Appeal

Your appeal paragraph starts out with a summary sentence explaining why you feel the denial was incorrect. After that, you will continue the paragraph with a detailed explanation as to how this procedure is the only way to help your medical condition. You should put emphasis on how your long-term health will be negatively affected by not having this procedure done.

Your Specific Request

If you can take on some of the costs of the procedure, then you increase your chances of the insurance company overturning its denial. Remember that the denial was more than likely a financial decision, and if you can alter the financial conditions then you might be able to get the insurance company to see things your way.

You should get your doctor actively involved in helping you to write this letter. Your doctor will help you to utilize the medical terms in a way that will make sense to the insurance company. You might also want to invest in opinions from specialists to include in your letter to help make your case clearer.