There are occasions when decisions made are in error or do not meet what we think they should have been. On these occasions, an Appeal Letter is in order. The following Appeal Letter is an example of an appeal to an insurance company denying benefits.

Name
Street Address
City, State, Zip

Date MM/DD/YYYY

Dear Claims Review Department:

I am writing to you regarding to a claim sent to you by [Medical Provider] for [patient]. The charges were entered on [Date] and totaled [Claim dollar total]. [Health Plan] has denied payment for this procedure, stating that the Home Health Agency was not licensed at the time of receiving the procedure.

The State of Kansas does not require a Home Health Agency to be a licensed provider. Home Health Agency visits are a covered expense under the plan I have. I am requesting that you reconsider your denial for this procedure. I am including with this appeal letter, written documentation that supports this statement.

I request you reconsider this denial. I can supply more information if needed if it will help with this matter, please let me know what other pertinent information you may need. Thank you for your time and help in this matter.

Sincerely,
[Insured Name]