Does anyone know how to write a letter of appeal to an insurance company?
January 25th, 2011
Question by Sexy Mama: Does anyone know how to write a letter of appeal to an insurance company?
So in July I ended up loosing my baby at 14 weeks pregnant, i had to get a D & C done but my primary doctor was out of town. They had another doctor do the procedure and the doctor was covered but my insurance id denying the claim for the hospital saying that they are not providers for that Hospital. my problem is that i did not set up the surgery for the hospital my doctors office did the nurse asked me, the day i found out, What hospital i would like to go to have the surgery done at? My exact words were “I don’t care as long as they take my insurance” went home and the next day i had everything done. Now i don’t know what to do i have this huge medical that i can pay for? Does any one know how to go about writing a letter of appeal? Thanks for your help.
Also the doctor had told me that it was an emergency and that it needed to be done immediately but i couldn’t go threw with it on the same day i found out. I lost the baby at 12 weeks it was 14 weeks when i had the D&C done. Thanks
Best answer:
Answer by zippythejessi
I’m so sorry for your loss. (How much does it suck to have this added on to it? Geeez.)
First enlist the help of both your doctor and the doctor who did the procedure. They’ll probably be willing to help – since it’s going to them paid. Tell them you’ll keep them in the loop about what’s going on and if they can help you with medical documentation, you’d REALLY appreciate it!
Second. Call the insurance and ask for the appeals address – including any contact name and phone number, if applicable. Ask them what they need – sometimes, they just want a copy of the doctor’s notes, sometimes they want a pint of blood. (Almost literally.)
Next, gather the information – get supporting letters of medical necessity from the doctors. From your regular doctor – a note of that the covering doctor was covering while your regular one was out of town. From the covering doctor – a letter stating that it was an emergency and needed to be done sooner than later – and their reason why. The more documentation, the better!!
You write a letter telling the insurance that you are asking them to reconsider the denied charges because it was medically necessary and the attached documentation will prove it. KEEP COPIES OF ALL OF THIS!!!!
Send them to the appeals address, with a return receipt requested. Once you have that reciept, start calling to follow up (“check status of the appeal”) about two weeks after they receive it. You may have to be a royal pain in the you know what to them, but squeaky wheel gets the oil! I find if you drown the insurance with paperwork showing them you’re not going away, they give up and give in.
Good luck!!
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