Appeal Letter Sample

Sample Letter of Appeal

Send an appeal letter when you are notifying the recipient that you are appealing something. You will sometimes write a letter like this on behalf of someone else, such as your child, your elderly parent, or someone who has placed you in charge of his or her affairs. Sometimes, appeal letters are professional in tone and style, but they can also be more informal and conversational, depending on the situation and context. The style and wording you use in a letter depend on the specific circumstances.

It is generally best to keep letters as short and concise as possible while still communicating the necessary information. Feel free to customize and modify any of these letters according to your individual needs.

NOTE: In all letters, brackets indicate information that you should fill in. Remove the brackets when you have modified the text to your liking.

Sometimes, decisions made are made improperly or based on erroneous information. On such occasions, a letter of appeal is appropriate. The following letter is an example of an appeal to an insurance company that denied a client his or expected benefits.

Street Address
City, State, Zip


Dear Claims Review Department:

I am writing about a claim sent to you by [Medical Provider] for [patient]. The charges were entered on [date], and they totaled [dollar amount]. [Healthcare Provider] has denied payment for this procedure, stating that the home health agency was not licensed when the procedure was conducted.

The State of Kansas does not require a home health agency to be a licensed provider. Home health agency visits are covered under my insurance plan. Therefore, I request that you reconsider your refusal to pay for this procedure. I have attached written documentation that supports my position.

Please reconsider this denial. I can supply more information if necessary or helpful; let me know what other pertinent information you may need. Thank you for your time and for your help in this matter.


[Insured Client's Name]

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