Free appeal letter 14Free appeal letter 14
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Sample appeal letter for health claim

Use this letter as a guideline when appealing a health insurance claim denial. In order for the letter to be effective,
you should personalize it by putting it into your own words.
Rewrite the letter, inserting your personal information in the areas indicated in red. You can print out this PDF and
make your changes by hand or copy the body of the letter and paste it into a document where you can make your
changes on your PC.



Insurance Company name


City, State and ZIP Code

Re: Patient’s name

Type of coverage

Group number/Policy number

Dear Name of contact person at insurance company,

Please accept this letter as patient's name appeal to insurance company name decision to deny coverage for state
the name of the specific procedure denied. It is my understanding based on your letter of denial dated insert date
that this procedure has been denied because: Quote the specific reason for the denial stated in denial letter.