Response Letter to Denial of Medical Insurance Claim

					This is a response letter to a medical insurance carrier who has previously denied
medical insurance coverage to the policy holder. The letter asks the medical insurance
carrier to review additional documentation and reconsider allowing coverage of the
claim. This document should be used by medical insurance policy holders who have
had claims under their policy denied.
                    ___________ [Instruction: Insert Policy Holder Name]
                        ___________ [Instruction: Insert Address 1]
                        ___________ [Instruction: Insert Address 2]

                                                          ___________ [Instruction: Insert Date]

___________ [Instruction: Insert Medical Insurance Carrier Name]
___________ [Instruction: Insert Address 1]
___________ [Instruction: Insert Address 2]
Attn: ___________ [Instruction: Insert Name of Person Who Signed The Denial Letter]

      Re:    Insurance Policy # ___________ [Instruction: Insert Number] – Claim #
___________ [Instruction: Insert Number] – Denial of Claim

Dear ___________ [Instruction: Insert Name of Person Who Signed The Denial Letter:

       On or around ___________ [Instruction: Insert Date], I filed the above-referenced
claim regarding ___________ [Instruction: Insert Reason For Claim].

        I recently received a letter dated ___________ [Instruction: Insert Date], indicating that
the claim has been denied because “___________.” [Instruction: Insert Quote from Letter
about why claim was denied]

       I disagree with this decision and believe if you had all of the necessary information at the
time of your initial review, you would have come to a different conclusion. Accordingly, I ask
you please review the following enclosed additional documentation, all of which supports the
approval and processing of my claim.

             (1) ___________ [Instruction: Insert Name of Supporting Document 1]
             (2) ___________ [Instruction: Insert Name of Supporting Document 2]
             (3) ___________ [Instruction: Insert Name of Supporting Document 3]

       Based on this additional information, I am asking that you reconsider your previous
decision and allow coverage. Please feel free to contact me if you will require further additional
information.

       I appreciate your assistance with this matter and look forward to your response.

                                      Very truly yours,


                                      [Instruction: Sign]

                                      _____________       [Instruction:   Insert   Policy   Holder
                                      Name]

Enclosures

				
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posted:5/14/2012
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Description: This is a response letter to a medical insurance carrier who has previously denied medical insurance coverage to the policy holder. The letter asks the medical insurance carrier to review additional documentation and reconsider allowing coverage of the claim. This document should be used by medical insurance policy holders who have had claims under their policy denied.