Insurance Denial with a Well-Written Letter

insurance letter

What if a few magic words could get you thousands of dollars in insurance coverage?

This may sound like something out of a modern fairy tale. However, for those whose insurance claim has been denied, this is a very real opportunity.

It’s possible to appeal an insurance denial, and it all starts with writing a letter. However, what you write (and what you don’t write) is what makes all the difference.

Wondering how to appeal an insurance denial? Keep reading to learn all the secrets!

Do Your Homework

Writing a letter to appeal insurance denial is very difficult. However, most of the difficult parts come before you actually start writing.

For instance, you’ll need to do your homework up front. Sure, you know your claim was denied, but do you know why it was denied?

It’s important to understand the stated reasons for the denial as well as the exact language the insurance company used. You’ll need to compare the letter of denial they send to you with any explanation of benefits (EOB) paperwork that you were sent.

Think of all this information as ammo for you to use in the actual letter.

Be Upfront

Speaking of the actual letter, you shouldn’t beat around the bush. What we mean is that you must be upfront about why you are writing.

In addition to having things like your name and contact details up front, your letter should also clearly state your intent.

Fortunately, it’s easy to do this.

Start out by requesting that the company accepts this letter as an official appeal to their denial of coverage. Be sure to specify the company name as well as the procedure that is being denied.

You’ll need to have more in the letter later on, but it’s important to have this kind of info up front.

Talk to Your Doctor

You might think that writing a letter of appeal is a solo activity. Well, spoiler alert: you and your doctor are going to have to tag team this.

For instance, you may need to request that the doctor change the phrasing of their request. Very often, claims are denied because the wording that your doctor uses conflicts with the wording that the insurance company uses.

Bring your insurance company guidelines to your doctor. Chances are that they will be able to rephrase the request for a procedure in a way that fits those guidelines.

Collect Evidence

A more basic reason that insurance may be denied is that the company thinks that it isn’t medically necessary. Your letter needs to include evidence that it is necessary and a narrative that ties this evidence together.

This may include prescriptions, referrals, letters from your doctor, and so on. You might think the company already has this information, but a letter of appeal is a unique chance to put all of this information in the same place for review.

If your claim stems from something like a car accident, then documentation related to that incident should be included.

Gathering evidence and including it can also be a time saver for the future. If your initial appeal letter is denied, this evidence can help you write a second appeal.

Get a Letter

We mentioned this in passing, but let us be explicit. Your own letter of appeal should include a letter from your doctor.

A letter from your doctor can help convince your insurance company that this procedure is truly necessary. Furthermore, collaborating with your doctor when they write this additional letter can help you learn more about writing your own letter.

One consideration is to cut out the middleman. Many patients have their doctors write a letter of appeal directly instead of writing a separate letter and attaching it to their own.

Regardless of the path you take, invoking the extra authority of your physician can go a long way towards your letter being effective. Having a personal lawyer can also help: read more here!

Talk to Insurance Company

You may have heard a simple motto from your parents growing up: “when in doubt, ask.” This motto also happens to apply to insurance coverage claims.

If you haven’t already, you need to contact your insurance company and ask them a simple question. Specifically, you need to ask why your claim was denied.

This helps you write your letter in a couple of different ways. First, the company can help you understand the technical jargon behind why the claim was denied. Without this understanding, writing the letter is impossible.

The company can also clarify things like the limits of certain kinds of coverage. Knowing that can help your doctor with any rephrasing of your medical request they may write.

Provide the Numbers

There are many schools of thought regarding how to write a letter of appeal. We like to keep things simple, which is why we think your letter needs to make things easier for your insurance company.

One of the best things you can do is to provide any numbers they require directly on the letter. This includes your address, phone number, and policy number as well as insurance type.

It really is that simple. By making things easier on the people handling your appeals, you make it likelier for your appeal to go through.

Save Them Money

Here’s a cynical fact for you: the universal language is money. And this is your insurance company’s preferred language.

One reason they may initially deny your claim is that they think it is too costly. Your letter is an opportunity to convince them that providing coverage for you will actually save them money in the long term.

For instance, you can spell out the kinds of alternative treatments you will be forced to get if this initial treatment is denied. It may turn out that denying a claim for a few hundred dollars could cost the insurance company a thousand dollars or more.

Convince them they can save money and your appeal is much likelier to succeed.

Leave a Reply

Your email address will not be published. Required fields are marked *