Sample Letter to Insurance Company Contesting A Denial of Coverage

Name of Medical Director

Name of Your Insurance Company

Street Address

City, State, Zip Code

Dear Medical Director:

__________________________ (insert name of your insurance company) has denied my claim for ________________ (insert specific information about the name of the therapy, drug, wound care supplies, etc.). My physician and I disagree with your ruling on my case. Please send me information detailing how I can appeal your denial of my physician prescribed, medically necessary therapy.

Sincerely,

Your Name

Your Address

City, State, Zip Code, Telephone Number

cc: Your Physician


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