Medical Appeal Letter

Expenses incurred during hospitalization are at times quite high and we try to claim the expenses incurred, from our employer or the health insurance service provider. Many organizations provide medical coverage to employees and their family. Besides, people also opt for private medical or health insurance plans, and when they are in such a situation, they get cashless facility, or have to later claim their expenses from the service provider. To claim the expenses either from the employer or the service provider, the individual has to write a medical appeal letter.

A medical appeal letter is written in two situations -

1. To appeal for medical claim
2. To challenge the denial of claim by the service provider

In the first case, the appellant appeals for claiming his/her medical expenses. In the second situation, the appellant has already requested for a claim, but has been denied the claim and he/she appeals again, so that the service provider reconsiders the denial decision and presents the justification of appeal.

Every appeal letter has the same purpose, and follows the same format. Only the reason of appeal varies. The purpose is to bring to notice something that the appellant feels is unjust, and is incorrect because certain facts and evidences were not considered. Let us discuss the format of the letter, followed by a medical appeal letter that would help in better understanding of the concept.

Format of an appeal letter:

• The appeal letter is strictly a formal letter. The use of informal language or emotional cues is strictly not allowed in appeal letters. The purpose of this letter is to make the reader rethink over his/her decision or action. Thus, it has to be to the point, and more emphasis should be laid on facts and evidences supporting the appeal.
• The letter follows a typical format. It begins with the date, and name and address of the appellant on the left hand side of the page, leaving a margin of 1.5 inches from the top of the page.
• After the appellant's name and address, comes the reader's name and address.
• The subject line or reference line, as also known, gives the reader complete idea of the purpose of the letter. It clearly states what the appellant expects from the reader.
• The body of the letter usually consists of three paragraphs. The first paragraph is a mere introduction of the appellant, and states the appeal.
• The second paragraph of the letter needs some homework from your side. If you are appealing against a denial decision, incorrect decision, or making a fresh appeal, you need to collect the supporting information. In case of denial, read the denial letter thoroughly, and compare it with the terms and conditions discussed with you, or the laws pertaining to the decision. If you are making a fresh appeal, reading some sample appeal letters will help you understand what information would be needed to make your appeal strong. Incorporate all the necessary information in this paragraph of the letter.
• In the last paragraph, state your appeal again and the main facts that make your appeal strong. Close the letter by thanking the reader.

Read the sample medical appeal letter given below:

14th October, 2011
Rose Hunt
Denver Lanes
Long Woods Blvd.
Seventh Street
Downtown
California - 32450
Ph: 33 451 212

To,

The Manager
Mr. Bob Pekker
On Spot Medical Finance Solutions
Seventh Street
Downtown
California - 32453

Re: Appeal for medical claim of $50000; Policy no. CA 652

Dear Mr. Pekker,

I am Rose Hunt, and this is to appeal you for a claim of $50000 expenses incurred at City Hospital, California. As per the terms and conditions of the policy, I am now claiming for the expenses incurred, as we do not have cashless facility, along with the Silver Policy.

I was admitted in City Hospital last week, and underwent a minor leg surgery after I met with an accident. It was a bone fracture and ligament tear case. Dr. Pearl Thomas, advised me to undergo this surgery for better recovery. I have enclosed a letter from her, medical reports, and hospital bills for your reference.

Please look into the matter and consider my appeal for the claim at the earliest by reviewing the necessary documents send along with the letter.

Thank you.

Rose Hunt.

Enclosure:

1. Letter from doctor
2. Medical bills
3. Medical reports

This sample medical appeal letter will help claim your medical expenses with ease. Also, you can refer to Charity Appeal Letter and Dismissal Appeal Letter for more samples.