In case your health insurance claim just got denied, you are probably wondering what step to take next.
One thing you can do is make an appeal. But for that, you need to know the procedure first. So how do you make an appeal exactly?
First of all, even before you touch your pen or keyboard, it is important to contact your doctor’s office and ask for all the important information that you may need to include in your letter. You can also get helpful suggestions from knowledgeable staff there. In addition to that, the office may have a great letter template to help you complete the appeal process easily and quickly.
Secondly, you need to obtain some basic information from your insurer in a standard denial letter.
Once both of the above steps are completed, it is time to write the actual letter.
In order to be effective, your Bariatric Surgery appeal letter should contain the following six elements at the very least:
Basic policy information
It goes without saying that your letter must contain your name in full at the beginning. The letter must also contain policy information and treatment information. You can find such information easily if you examine your insurance company’s Explanation of Benefits document. Writing your policy number, treatment dates, description of treatments, and total doctor fees should be enough.
The reason for denial
Why was your claim denied in the first place? State that reason in your letter. Make it easy for your insurance provider to track your case. Do not assume that your insurance company will just know the reason.
Make it clear that the reason for writing your letter is that you intend to make an appeal.
Important document copies
Send all the records that your insurer used at the time of denying your claim. Also, include records that may be required to approve your claim if the company chooses to do so. In addition to that, do not forget to enclose copies of medical opinions provided by your insurer regarding the denial.
Claim re-review request
Request your insurer to review your claim once again in accordance with any newly provided data. This one applies only if you provide additional documents or information responding to the denial.
Your contact information
Never end a letter abruptly without giving your contact details. Where would you like to be contacted for further correspondence by your insurance company? Write down that address correctly at the end of the letter.
If all else fails, you can still get medical financing. Read more about bariatric financing here.