Example-of-not-medically-necessary-appeal-letter.doc

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Example letter for a “not medically necessary” denial Situation: A medical provider billed you for a denied claim. You decide to appeal the denied claim since you asked how much it would cost before receiving the services and the doctor who is contracted by the plan told you the plan would cover the ultrasound after a $30 copay. [Your name, address, policy number] [Date] [Contact information for your insurer’s appeals department] To whom it may concern: I’m appealing your company’s decision to deny payment to Dr. Wilson for the ultrasound I received on 3/14/13 – Claim No. 2596BG. The reason listed on the denial is “not medically necessary.” Before I had the ultrasound, I asked Dr. Wilson’s office, which is a contracted provider,
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