Dear MrMsDirector of Claims name if available You recently denied a claim on the grounds that the care provided by name of provider on date of services was not medically necessary.

Sample letter of insurance claim appeal. Policy Number NUMBER appeal for claim denied. Dear Name of Claims Director. Dear Name of Administrator.

Sample Health Insurance Appeal Letter. Use of this template or the information in this template does not guarantee reimbursement or coverage. Respected SirMaam This is to bring it to your notice that I would like to claim my insurance amount of policy number L-39848 which I had enrolled in the year ____date.

Sample insurance claim appeal letter I appeal for a reconsideration of the health insurance claim of my father Mr. Sample Letter To Appeal A Medical Claim Denial. Sample 2 Health Insurance denial Appeal Letter Your Name Your Address City State Zip Code.

Insurance Administrators Name Insurance Companys Name Insurance Companys Address City State Zip Code. It should clearly state the customers name address and policy and claim number and be written in formal business style. Sample 2 - Appeal Letter for Medical Claims Name of Policyholder Address of Policyholder City State Zip Code DATE Director of Claims Name of Insurance Company Address of Insurance Company City State Zip Code RE.

Jamie Smith Medical Coverage G89078723746 908765678 Group numberPolicy number Dear Virginia. My father has been diagnosed of a major heart disease on the date. See sample below for more information on a typical appeal letter.

Please customize the appeal letter template based on the medical appropriateness. I am scheduled to have one of my kidneys removed due to a health condition. The explanation of benefits did not give adequate information to establish the validity of this decision.