Sample Letter for Appealing a Health Insurance Claim Denial

Letter for Appealing a Health Insurance Claim Denial

May 13, 2019

Virginia Snyder
Blue Cross Blue Shield Insurance Company
9870 Cross Street 
New York, NY 10024

Re: Jamie Smith
Medical Coverage –G89078723746 908765678
(Group number/Policy number)

Dear Virginia:

Please accept this letter as an appeal to Blue Cross Blue Shield’s decision to reject coverage for the colonoscopy procedure. It is my understanding based on your notification of refusal of services dated April 20, 2019, that this procedure has been denied because:

A colonoscopy will not be approved more than once in a twelve month period without the presence of cancerous or precancerous cells. 

As you know, I was identified as having Irritable Bowel Syndrome on February 20, 2019. Currently Dr. Jonas believes that I will considerably benefit from a second colonoscopy. Please see the enclosed letter from Dr. Jonas that discusses my medical history in more detail.

I believe that you did not have all the necessary information at the time of your initial review. I have also included with this letter, a follow up letter from Dr. Jonas from OSU Medical Center. 

Dr. Jonas is a specialist in Columbus, Ohio and he is one of the top ranking individuals in his field. His letter discusses the procedure that is needed in more detail. Also included are my medical records, explaining why this additional procedure is necessary. 

Based on the current information, I am requesting that your company reconsider allowing this procedure and cover my colonoscopy as Dr. Jonas outlines in his letter. The treatment is scheduled to take place on June 1, 2019, pending your approval. 

Should you require additional information, please do not hesitate to contact me at 440-710-3456. I look forward to hearing from you regarding this matter. 

Sincerely,

Jamie Smith