What information should be included on a health insurance appeal letter?

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  1. Lwelch profile image92
    Lwelchposted 6 years ago

    What information should be included on a health insurance appeal letter?

    This is for an approval for an increase in my triptans per month.   I have done preventatives and etc I just need to know how to format the information in a professional manner.

  2. Ericdierker profile image46
    Ericdierkerposted 6 years ago

    Hey Lwelch,
    No you do not have to present a professional letter professionally. You are a great writer with a solid logic aptitude. You are very literate and you are real smart.
    Take your relevant paperwork and read it 8 times -- until the wierd insurance lingo is in your head.
    Buddy, the trick part and the real chance to be the creative writer you are is to find out some small error someone in the Insurance company commited -- hey, a misspelled name or important word with do, but we always want something more substantive. Then write a rant on it, only tying it into your matter a little.
    Good con men, sometimes get reformed but one thing that always sticks with them is that distraction will always work.
    Now you are in a position to be magnanamus and let them off the hook, so now all they have to do to get rid of you is grant your appeal.

    1. Lwelch profile image92
      Lwelchposted 6 years agoin reply to this

      *chuckles* thanks for the answer and complement.  I spent today trying to find  in writing  what the actual plan has down as the limitations for triptans.  Amazingly, not to be found.  Guessing I will have to get it faxed to me to see the fine print.

  3. carol3san profile image60
    carol3sanposted 6 years ago

    I would just lay out the facts of the case logically.  I would remind the insurance company of their agreement to provide  the service that they are now denying.  This of course is considered to be a breach in their contract.

  4. quildon profile image77
    quildonposted 6 years ago

    Was the increase ordered by your doctor? Because if it was, you can ask your dr to give you a letter stating that the amount is medically necessary, then include it with your request stated in a logical manner. That should do it.

    1. Lwelch profile image92
      Lwelchposted 6 years agoin reply to this

      My doctor tried to get a prior authorization approved.  They only approved part of it.  It is more than standard but less than I have been using for the last 10 years.


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