Free appeal letter 27Free appeal letter 27
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Sample Appeal Letter: Client Does Not Need High-Tech Device
(DATE)
(INSURANCE NAME)
(INSURANCE ADDRESS)
(INSURANCE CITY, STATE
ZIP)
RE: (FULL NAME OF
CLIENT) DOB: (DATE OF
BIRTH)
To whom it may concern:
I recently submitted a request for purchase of the (DEVICE NAME) for my client, (CLIENT’s
NAME), who has a medical diagnosis of (DIAGNOSIS) and a speech-language diagnosis of
(DIAGNOSIS). These diagnoses have left (HIM/HER) functionally nonverbal and unable to
adequately express (HIS/HER) medical needs in an effective way without the use of
Augmentative-Alternative Communication (AAC). As outlined in the AAC Evaluation Reported
dated (DATE OF YOUR ORIGINAL REPORT), it is medically necessary for (CLIENT) to have
access to a speech-generating device (SGD) so that (HIS/HER) medical needs can be
expressed and met. (DOCTOR’s NAME) was in agreement with my recommendation for
purchase of the (DEVICE NAME) as the most cost-effective solution for meeting (CLIENT’s)
current medical communication