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To Whom It May Concern: I am writing to request a review of your denial of the claim for treatment or services provided by name of provider on date provided. The reason for denial was listed as (reason listed for denial), but I have reviewed my policy and believe treatment or service should be covered.
Your Step By Step Checklist Note the strict timeframes. ... Don't ignore details in the denial letter. ... Don't panic. ... Gather information. ... Carefully compose your administrative appeal letter. ... Ask for help. ... Provide proof of disability. ... Include your friends and family's declarations and statements.
Make Sure the Letter Includes Details Tell your doctor that, while you appreciate it, a letter that only indicates that you are ?unable to work? is not enough. Ask him to discuss your specific limitations and how they adversely affect your ability to do your job.
The letter should include such information as: The claimant's medical condition(s) Medical evidence such as diagnostic test results. The doctor's medical opinion about the claimant's limitations. An explanation of how the medical evidence supports the doctor's opinion.
Content and Tone Opening Statement. The first sentence or two should state the purpose of the letter clearly. ... Be Factual. Include factual detail but avoid dramatizing the situation. ... Be Specific. ... Documentation. ... Stick to the Point. ... Do Not Try to Manipulate the Reader. ... How to Talk About Feelings. ... Be Brief.