Preparing a Written Appeal Letter for Insurance Company

If you find it necessary to file a written appeal of a decision made by an insurance company about your medical care, you will want to include information falling into four basic categories:

  1. Medical Records
  2. Your Appeal Letter
  3. A Letter From Your Doctor
  4. Supporting Documents (research, practice guidelines, etc.)

This is a list of things to research and focus on in preparing to write your appeal letter:

  • Focus on the stated reason for the denial. Some common reasons include: unsupported therapy, experimental therapy or an uncovered service.
  • Applicable plan benefits and rules that support your assertions.
  • Review standards of care, practice guidelines and guidance from professional societies.
  • Peer-reviewed research studies on use of this treatment or medication for people with your condition.
  • Try to understand the insurance company’s position so you can argue against it.

Here are some tips for things to include when writing your appeal letter:

  • Information that identifies you and the decision you are appealing: policy number, group number, claim number, etc.
  • State the reason they gave for their denial decision.
  • Provide a brief history of your condition and why this treatment is necessary.
  • Specify why you believe they made the wrong decision.
  • Reference any research you found that demonstrates the treatment is not experimental or unsupported and include it in the packet with your other appeal documents.
  • Address whether the treatment or medication is FDA approved for your disease or any purpose.
  • If you believe they based their decision on incorrect information, make sure to address this and provide the correct information.
  • Be specific: Ask them to reconsider their denial decision and do so in a timely manner.

Often examples can be very helpful when you are unfamiliar with the ins and outs of a process. You can download a sample in PDF form at this link: Sample Appeal Letter.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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