At Resolve, we’re writing insurance appeal letters constantly, and know know that filing an insurance appeal letter can seem like a daunting or confusing task. Learn how to understand and file your insurance appeal letter, the key terminology to know, and the top tips for filing it from our team below.
What is an Insurance Appeal Letter?
An insurance appeal letter (or appeal form) is a standard document you can submit to your insurer in order to appeal a medical bill or claim denial. If you believe your claim has been denied in error, you have the right to submit an appeal.
How do I get an Insurance Appeal Letter?
The required paperwork and process for filing an insurance appeal should be available in your insurance company’s online portal. If you need help, you can call your insurance company and ask directly.
Understanding your Insurance Appeal Letter
An insurance appeal will typically include the following components:
- Policy information: your name, policy number, group ID and other information to identify you
- Provider information: the provider from which the claim was denied
- Open appeal: a section of the insurer’s standard form with space to describe the reasons for your appeal and the outcome you are requesting
- Supporting documentation: in addition to the insurer’s required standard form, your appeal may include additional evidence to support your appeal. This may include your medical records, a doctor’s note, a referral from your primary care physician to the provider, evidence of incorrect diagnosis or treatment codes and descriptions.
The Insurance Appeal Letter Terminology to Know:
- Explanation of Benefits
- Medical Necessity: claims are frequently denied because a procedure is not deemed medically necessary and is therefore not covered by your policy.
- Medical Emergency: claims for emergency service may be denied if the insurer determines that there was not a medical emergency
- Out of Network
Beyond insurance appeals, you may also find it helpful to understand these additional key health insurance terms, so you can be as prepared as possible when discussing your medical bill with your insurance company or hospital.
Tips for Understanding and Filing an Insurance Appeal Letter
- Know the requirements and deadlines
- Stay organized
- Prepare evidence
- Follow up
If you have concerns about your medical bills and need assistance regarding your insurance appeal letter, or simply need help negotiating your medical bills, get in touch with our medical bill advocates at Resolve today.