Responding to Medicare and/or Insurance Requests and Denials: Template for Appeal Letter and Example Appeal Letter

Introduction:

This resource can be utilized when writing a letter of appeal to an insurance company for denial or reduction of services. It is important to verify the original authorization of services prior to treating, in addition to verifying what service or codes are specifically being denied. Often an entire service claim will be denied due to a technical error and in those instances, a request for re-authorization with submission of the corrected data is necessary. If the service is being denied or reduced for another reason, the letter from the insurance company will state the reason. This is what should be addressed in your response and request for reconsideration. Each insurance has different rules in regard to authorization of services. It is recommended that you request written authorization in addition to the authorization number prior to billing for services. Patients may not be aware of their specific plan’s rules and coverage; however, they can request a hard or electronic copy at any time.

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