Sample Appeal Letter For Health ClaimSample Appeal Letter For Health Claim
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Financial Literacy 2007

18 part series

Sample appeal letter for health claim
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.

Form letter for denial of specific medical procedure
Date
Name
Insurance Company name
Address
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 inser