Did you know that around 1 in 5 medical claims are denied each year? That’s millions of dollars in unpaid bills for healthcare providers. When a claim gets denied, writing an appeal letter can be your best chance to get it paid. An appeal letter is a formal way to ask the insurance company to review its decision. If you write it well, you could increase the chances of getting your claim approved. This guide will show you how to write an appeal letter that actually works.
Healthcare providers often face denials for multiple reasons when processing insurance claims. Some of the main causes of denials are:
Incorrect coding or billing can lead to claim denials.
Insurance companies may deny claims because the procedure was not medically necessary. It can be denied even if the provider considers it essential.
Claims that require prior authorization may be denied if there is an administrative error or miscommunication.
Letter of appeal is crucial because it allows providers to:
When you write an appeal letter, keep it short and clear. Here’s what you need to do:
At the top of your letter, write your practice’s name, address, and contact details. Don’t forget to put the date!
Make sure you send your letter to the right person. Write down their name and title. If you know the person who denied your claim, send it to them.
The subject line should be clear so the person knows what the letter is about.
Letter of appeal examples
“Appeal for Claim Denial – Claim Number [12345]” or “Appeal of Denied Procedure for Patient [Patient Name] – [Claim Number]”
Start with a polite greeting. You can say:
“Dear [Claims Department Representative’s Name],” or “To Whom It May Concern,”
In the first part, tell them why you’re writing. Mention the claim number, date, and why the claim was denied. Example:
“I’m writing because I want to request you to look again at claim number [Claim Number] for patient [Patient Name]. This claim was sent on [Date]. It was denied because [Reason for Denial, like ‘no prior approval’ or ‘the service wasn’t needed’].”
Now, tell them why you think the decision was wrong. You can:
Make sure you mention any important documents, like:
Example:
“The procedure done on [Date] was necessary for treating [Patient’s Condition]. The attached records from [Provider Name/Facility] show this was the only choice based on the patient’s history. The denial said the service was ‘not medically necessary,’ but the doctor, Dr. [Physician Name], recommended it. Please look at the medical records attached.”
Politely ask them to look at the documents again and change the decision. Be clear about what you want. Example:
“Please review the documents and reconsider your decision. We think the service is necessary and should be paid for.”
Thank them for their time and say you’re happy to give more information if needed. Example:
“Thank you for your time and attention. If you need more information or documents, feel free to contact me at [Phone Number] or [Email Address].”
End with a polite closing, like “Sincerely” or “Best regards.” Then add your name, title, and practice name if needed.
If your appeal gets denied again, don’t worry! You can still try a few things to change their decision:
If you want your practice to get paid, writing an appeal letter can really help. The letter should be clear and easy to read. You need to include facts that support what you are saying. When you write it like this, the insurance company can better understand your side. This might make them change their decision. Always remember to follow up and send any papers that can help your case. Appeal letters help healthcare providers get paid fairly and keep their business running smoothly.
By outsourcing your billing services to us, you can expect revenue growth of up to 20%
Please provide the following information, so our team can connect with you within 12 hours.
Or call us as 800-640-6409
