Free appeal letter 42
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Sample Appeal Letter B
[Date]
[Name]
[Insurance Company Name]
[Address]
[City, State ZIP]
Re: [Patient's Name]
[Type of Coverage]
[Group number/Policy number]
Dear [Name of contact person at insurance company],
Please accept this letter as my 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]
I have been a member of your [state name of PPO, HMO, etc.] since [date]. During that
time I have participated within the network of physicians listed by the plan. However, my
primary care physician, Dr. [name] believes that the best care for me at this time would
be [state procedure name]. At this time there is not a physician within the network who
has extensive knowledge of this procedure. Dr. [name of primary care physician], a plan
provider, has