Sample Cover Note To A Doctor About How To Help With An Appeal
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To: (name of doctor)
From: (your name)
Date:
Re:
Dear Dr. XXXXXXX:
My health insurer, (name of company), has recently denied coverage for (describe denied medical situation).
The company stated that the reason for denying coverage was: (state reason for denial).
In order to appeal the company’s decision I need to provide (state what is needed for the claim to be decided in your favor).
Please at least state in the cover letter:
- Your qualifications.
- Your source of knowledge on the matter, such as experience in the specialized area, additional training, articles from journals, or the like.
- The nature of our relationship.
- Detailed medical information supporting the use of the treatment or procedure or new use of a drug.
- The source of your knowledge on the matter, such as experience in the specialized area, additional training, articles from journals, or the like.
- Resources to support your recommendation
If it is accurate, please include a statement to the effect that denying the subject request is likely to have a negative medical impact on my health and life and be more costly in the long run.
Thank you in advance for your prompt attention to this request.
All best,
(Your name, address and telephone contact information)
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