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Sample Health Insurance Appeal Letter

An insurance appeal letter needs to be sent to your insurer explaining details associated with your claim, if you have been denied payments on unreasonable grounds. Along with the letter you'll need to send the documents to verify your statements.

Below you'll find a sample health insurance appeal letter which you can send to your insurer directly. Just fill in the necessary details.

Name of concerned person/Department
Insurance Company's Mailing Address
Company's City, State, Zip Code


Re: Patient's name
Type of coverage
Group/Policy Number

This is an appeal against the claim denial dated by your company. Your decision to deny coverage for was based on the grounds that . I want to appeal against the claim rejection, since I think that the decision was not justified.
  • Name of the patient:
  • Name of the illness/disease:
  • Date of diagnosis :
  • Name of the medical center :
  • Date of admission :
  • Date of discharge:
  • Name of the doctor who was in-charge:
The details of the medical treatments are enclosed along with a letter from , explaining the procedure and the corresponding results.

Please provide details of the insurance representative and the opinion of the medical expert who reviewed the treatment records for .

This is required so that the treating physician might provide explanation for the necessity of the treatments as per the patient's condition. Also, inform which documents might be further required for you to approve the treatment.

Based on the above mentioned details, I request you to reconsider the health insurance claim. The information provided is true as to reflect the way the patient has been treated. If you need any further information, you may contact me at or mail me.I'll be expecting your prompt action in this matter.

Thanking you.

Your Signature 
Your Full Name  
Your Mailing Address  
Your City, State, Zip Code  

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