How do you write a letter of an appeal to an Insurance Company?

Question

So in July I ended up loosing my baby at 14 weeks pregnant, i had to get a D & C done but my primary doctor was out of town. They had another doctor do the procedure and the doctor was covered but my insurance id denying the claim for the hospital saying that they are not providers for that Hospital. my problem is that i did not set up the surgery for the hospital my doctors office did the nurse asked me, the day i found out, What hospital i would like to go to have the surgery done at? My exact words were "I don’t care as long as they take my insurance" went home and the next day i had everything done. Now i don’t know what to do i have this huge medical that i can pay for? Does any one know how to go about writing a letter of appeal? Thanks for your help.

Answer 1

I would send the bill - attention to the nurse who booked the hospital

Answer 2

You're in a rough situation. The procedure was not "emergent" therefore you were expected by the insurance to go to a covered facility. You are expected to have some reasonable knowledge of what hospitals in your area accept your insurance.
You may not be in a position to force them to pay - and may want to discuss this with an attorney.

I am sorry that this happened, but part of being a responsible adult is being an educated consumer and that includes your health care insurance and medical coverage.

Answer 3

You may want to chat with a lawyer. Since the insurance company does not accept the hospital you went to you may not be able to compel them to pay. A lawyer can sort this out be reviewing the insurance contract and see if anyone might be liable.

Answer 4

IT is your obligation, not that of the nurse to know the4 limitations of your coverage. It is an unfortunate situation, however you are not without liability.