What should an appeal letter look like to my insurance company that won't pay for my ER visit?

Question

If someone had a few minutes to write me up something sendable I would appreciate it to no end! I'm terrible at know what to write. Thanks very much.

Answer 1

First, you want to look at why they denied it. If you went to a contracted provider and the contracted provider did not do what they were supposed to do, it's not your responsibility. That's why they are contracted providers.

There are too many variables here to attempt to resolve, but I would exhaust all other avenues before considering an appeal. You may run out of valuable time while waiting on an appeal which is what I suspect they were designed for. So that people will sit back until the statute runs out on their claim.

Good luck

Answer 2

The first thing you need to do is to find out exactly why the insurance company denied your ER visit. What are they claiming the reason was for the denial.

I had a similar situation a few years ago. The ER visit was denied because the insurance company felt that a laceration to the wrist did not warrant an ER visit. The truth of the matter was that my son was playing tag, and not thinking the kids were using the storm door as base. My son pushed his hand an forearm through the storm window in the door. He slit his wrist open approximately 2 inches deep. The doctors office was closed and they would have sent him to the hospital anyway for a cut that deep. Once I explained the injury and talked with the hospital they assisted me in resubmitting the claim to my insurance company.

1) get the reason the claim was denied.
2) state the facts that justify the ER visit.
3) get the assistance of the Hospital/Attending Physician if necessary.
4) resubmit your claim.
5) be persistent if you have a valid claim.

Good Luck
Michelle'

Answer 3

Why won't they pay? If they are questioning 'medical necessity', you need to request your medical records from the visit to the ER & send them with your appeal letter.

Make sure you label your letter as an appeal & be sure to include your insurance ID #. And, keep a copy of your appeal for yourself.

Dear 'health insurance company',

I would like to appeal your decision to deny my ER claim(s) for services rendered @ "Hospital Name" on service date "12/34/56". (Then, you need to state why you feel it should be paid. Like:) The service was indeed medically necessary, and these services are covered. I requested the ER records from "Hospital Name", and have attached them to this letter. Please pay these claim(s) in questions as soon as possible. I am currently being billed by the service providers.

Sincerely,

Answer 4

on condition that we don't additionally be conscious of what got here approximately to generate a declare from an insurance organization ( the different guy or woman's of your individual ), how are we meant to answer your question wisely?

Answer 5

need more details...my insurance doesn't pay if you go to the ER and it really wasn't an emergency or there was no diagnosis....its very hard to argue w/ their decision. Sometime the ins. co will contact you to get more details about how the accident happened or what made it an emergency and if you don't respond they wont pay.

Answer 6

Dear company. You didn't pay my bill for (insert reason here). I am appealing this decision; in accordance with my policy terms, I think this should be covered because (put the reason you want it covered here). Please acknowledge this letter and respond within 30 days.

Signed, you.

Answer 7

Why do you say 'it looks like." Did you get a rejection letter & what dd it say?

I'd call them and ask for an explanation.
Letters take too long.

Answer 8

before you write that letter go see your agent and see if he will take care of the matter for you.