How to Make a Medical Bill Appeal Letter

Medical bill appeal letters are simple and straightforward. The letters are necessary to challenge decisions by insurance companies denying eligibility for benefits. For example, an insurance company may decline to pay for dental implant surgery because it considers the procedure cosmetic surgery. The insurance company also may refuse to pay for a procedure after ruling the patient did not qualify because of a pre-existing condition. Doctors usually receive authorization from insurance companies before granting treatment, but approval isn't final until the physician submits the bill to the insurance company. At that point, depending on the patient's coverage, the insurance company may pay for all or part of a procedure, or it may decline to pay anything.

Instructions

1

Review correspondence from the insurance company. The companies usually send letters explaining reasons for not paying claims. Review your policy and speak with your doctor's office to confirm that you have a legitimate complaint.

2

Call the customer service department for the insurance company. Find the telephone number on the correspondence, or check other records, such as your insurance card. Ask the representative for the address to send a medical bill appeal letter.

3

Write the letter. Get to the point in the first paragraph. Tell the insurance company you are appealing its decision to deny coverage and you are requesting a full and complete investigation. Include relevant information such as the type of procedure performed, the date, and your policy and Social Security numbers. Also include the name of the doctor or hospital performing the procedure.

4

State in the second paragraph that the procedure was necessary, proper and completed under guidelines included in your insurance coverage.

5

Address any specific issues noted by the insurance company in its denial letter. For example, the physician may not have submitted the claim in a timely way, or the doctor's office may not have requested pre-approval. Appeal these decisions by acknowledging the mistakes, if necessary, and asking for an exception.

6

Thank the insurance company for its consideration as you end the letter.