When denied for a claim, whether for insurance or a reimbursement of another sort, you may feel upset and shocked by the decision. But instead of giving up, the logical next step is to appeal the decision. If you feel you have a provable case that would validate your claim, build your case and write an appeal letter to send to the provider.
Determine the address and contact information for the appeals department of the provider that denied your claim. Use this information for the inside address of your appeals letter and keep the phone number on hand in case you need to call to ask additional questions of the provider.
Read the information about appeals conditions completely before composing your letter. Note the deadline for appealing the decision and make sure you submit your letter well before this date. This information and the appeal submission process is commonly included on the claim denial letter. Call the unit directly to clarify the appeal process if you're unsure.
Include the information required according to the appeal terms in your letter, including the claim number, account number, full name and your contact information as the claimant.
Discuss the purpose of the letter — to appeal a recently denied claim. Quote the reasons for claim denial.
Describe why the reasons for denying the claim are incorrect. Provide details and reference proof you have that shows you are entitled to reimbursement. Quote details of the provider's policy that verify your entitlement. Get help from a lawyer if necessary to hash out the details.
Ask the provider to reconsider the claim and re-evaluate it for approval. Provide your phone number and email address so that a representative of the provider can call you to clarify any information before making a decision on the appeal. Include copies of your evidence when you send the appeals letter and send the package via certified mail with a return receipt. In some cases, you may have to appear in person for a hearing to validate your claims.