Appealing a Denial of Coverage

Insurance appeal letter

The unfortunate truth of having to deal with an insurance claim is that something has probably gone wrong in your life. It could be an accident, a hospitalization, or damage to your property. Any one of these things is enough in itself to turn your life upside down. But when you add on a denial of a claim from your insurance company, the stress is exponentially greater. If you truly feel your claim was denied unfairly or incorrectly, you have the right (and perhaps the obligation) to write a letter of appeal to your insurance company.

Learning how to write an appeal letter for insurance is not as daunting as it sounds. In fact, you can find several insurance appeal letter templates online, where you simply download the file, fill in your own personal information, and state your case. Be sure you have all the pertinent account numbers, insurance codes (they should have provided you with these in the denial letter), and contact information. Then set about constructing your argument.

Find out what each denial code means and address each one individually. This may take some research, but the information is available. Bear in mind, too, that once you start your research, you may find that the denial code might indeed be valid for one reason or another. But if your research backs you up, then clearly and concisely present the reasons why you feel each particular code was misapplied. Be cordial and straightforward, and leave emotion out of it as much as possible. Try as best you can separate yourself from the personal issues the denial is causing, and deal with the matter in as businesslike a fashion as you can. More than one draft may be necessary.

If the dollar amounts are substantial enough, you may want to consider hiring a lawyer to write the letter for you. Lawyers already know how to write an appeal letter for insurance and a host of other situations as well, and if the amount the insurance company says you owe is a truly intimidating figure, it may well be worth the fee a lawyer would charge to make sure the matter is handled efficiently and professionally. Always be sure to weigh your options.

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