Having a health insurance policy is not a guarantee that all medical expenses will be covered. Most people expect everything to be covered after they pay the deductible, but many medical procedures are not covered by insurance.
According to experts, seven to 10 percent of medical bills are denied in error. The best way to get a bill covered that was denied is to write a clear and thorough health insurance appeal letter. The success rate of appealing medical claims is 40 to 50 percent.
This may be enough to settle the issue. If not, the next step is to write a letter.
Many people feel angry at the insurance company or the claims adjuster when a claim is denied. However, this letter is not the place to express anger, show irritation or be rude. The tone should remain professional and use compromising words like reconsider rather than making demands. Before drafting the medical bill appeal letter, the customer should examine their insurance policy to see if there is a time limit for making an appeal.
The letter should be sent within the time frame. The customer should also look for any language in the policy that will help back their appeal. If there is any statement concerning making appeals, it should be included in the letter.
Having a health insurance policy is not a guarantee that all medical expenses will be covered. Most people expect everything to be covered. Sample generic appeal letter. [Date]. Attn:______. Provider Appeals Department American Medical Association. Permission is granted to physicians to.
The customer should enclose any documents that support their request such as medical records, radiology reports, a letter from their doctor and any notes the doctor made. The following information should be given in the letter: This right applies to plans created after March 23, In addition, for plan years or policy years purchased on or after July 1, , the insurance company must inform you of why your claim was denied, your right to an internal appeal, your right to an external appeal if the internal review denies your claim, and the availability of a Consumer Assistance Program CAP if your state has one.
Internal reviews must also occur within specific timelines. A review for the denial of non-urgent care that you have not yet received for example, must occur within 30 days of your review request.
You can use this letter as a model for an efficient, effective appeal letter. You may also need to get help from a legal professional.
Make sure your healthcare provider knows any issues you have with insurance. Your provider may be able to help you. It should be sent certified mail, return receipt requested.