Denial of Medical Insurance Claim, Response

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Denial of Medical Insurance Claim, Response

Name Insurance Coverage In:

Plan #:

Family Name Covered Under Plan:

Individual Covered & Subject to This Letter:

Social Security Number of Individual:

Their Case Number, if one is assigned:

Dear Sir or Madam:

On ______________ (Date), a claim was filed with you regarding _________________.

We received notice, see Exhibit 1 attached, that the claim was denied.

This claim should not have been denied for the following reasons:

Additional documentation is also attached; see Exhibit 2, supporting our claim.

Please review the new materials submitted in order to reconsider your denial of the claim.

Please call me after you have reviewed the information I have submitted.

Please call us in the next few days so we can both take care of this promptly.

With best regards,

_______________

Writer

_______________

Family Member Under Whose Name the Plan is listed

Enclosures: Exhibit 1 & 2.