In Oklahoma, in 2012, there were more than 15,000 appeal cases for insurance. Writing insurance appeal letters is never fun, but it is often necessary if your provider has decided to deny your medical claim. When this happens, you will need to plead your case. They do not teach you how to do this in school, so here is your chance to learn how to write an appeal letter for insurance.
1. Gather information.
As with any important task, you should do your best to get together all of the important information you might need for your appeal. If you do this, you should be able to organize and write your letter more effectively. Research your policy so that you know all about the contract you signed. Once you are better informed about your own policy, you can present the facts with accuracy.
You will need the name of your medical provider, the date of the procedure, and the name of the Director of Claims to whom you should be addressing the letter. Also, keep the original claim denial at hand for quick reference.
2. Writing insurance appeal letters.
Be sure to include any and all information about the medical procedure for which coverage was denied, and a thorough record of any and all events that were related to that procedure. You should quote the reason for denial which your provider originally cited. Ask your provider if they asked for the opinion of any medical experts, and if they did, if you could receive a copy of their statements.
You may find it necessary to include a statement from your own doctor which explains why the procedure was necessary. Kindly request that they review your claim again, and be sure to provide ample contact information for them to get in touch with you.
3. Claim letter denial.
Not everyone will experience this step again, but many people will unfortunately go through the appeal process several times before achieving desired results. If you are denied again, then there are several options open to you. The first of which is to write another letter. Like I mentioned earlier, writing insurance appeal letters is never fun.
There are several insurance denial appeal letter templates available online, which should give you a near perfect example of what your own letter should look like. Remember that you should not lose hope, as the insurance claim process can be a long one. An attorney can also always be contacted to review your claim, and they may be able to help you with the process.