You received an insurance denial
An insurance denial reads like the end of the matter, and it usually is not. It is a decision with a stated reason, and most letters of this kind describe a way to ask for that decision to be looked at again.
What this letter usually is
A denial letter tells you the insurer will not pay for a claim, or will not approve a treatment in advance. It commonly names the policy, the claim or request, and the reason — a term not covered, a form not received, a treatment the insurer calls unnecessary. The reason is the part to read twice.
What it usually asks for
Often nothing, which is what makes it easy to put down. Many letters do describe a review or an appeal, and say what to send: records, a note from the treating doctor, the pages of the policy you are relying on. If yours mentions a review, the list of what to send is usually in it.
The deadlines that commonly apply
Denial letters commonly give a window for asking for a review, and it is often stated beside the address to write to. Your letter names who to write to and by when, or it does not. If it does not, asking in writing for the window and the address is a reasonable first letter on its own.
Three ways to respond
- 1Ask in writing for the full reason for the denial and a copy of everything the decision relied on.
- 2Ask for a review, setting out why the reason given does not fit your claim, with your records attached.
- 3Ask the professional involved — a doctor, a repairer, an assessor — to put their view in writing, and send it with yours.
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Frequently asked questions
CraftMyLetter writes and delivers letters. It is not legal advice, we are not a law firm, and nothing here is a statement of what any law requires.