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    Generic Appeal Letter

    Uploaded by

    King Sam
    This document provides a sample appeal letter template for physicians to use when appealing a denied health insurance claim. The 3 sentence summary is: The letter outlines identifying information for the insured and claim being appealed, states the reason(s) the physician feels the charges should be allowed, and provides contact information for the physician's office if additional information is needed. It also notes that the American Medical Association allows physicians to use this letter template in connection with their practices.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Generic Appeal Letter

    Uploaded by

    King Sam
    24 views1 page
    This document provides a sample appeal letter template for physicians to use when appealing a denied health insurance claim. The 3 sentence summary is: The letter outlines identifying information for the insured and claim being appealed, states the reason(s) the physician feels the charges should be allowed, and provides contact information for the physician's office if additional information is needed. It also notes that the American Medical Association allows physicians to use this letter template in connection with their practices.

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    This document provides a sample appeal letter template for physicians to use when appealing a denied health insurance claim. The 3 sentence summary is: The letter outlines identifying information for the insured and claim being appealed, states the reason(s) the physician feels the charges should be allowed, and provides contact information for the physician's office if additional information is needed. It also notes that the American Medical Association allows physicians to use this letter template in connection with their practices.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    24 views1 page

    Generic Appeal Letter

    Uploaded by

    King Sam
    This document provides a sample appeal letter template for physicians to use when appealing a denied health insurance claim. The 3 sentence summary is: The letter outlines identifying information for the insured and claim being appealed, states the reason(s) the physician feels the charges should be allowed, and provides contact information for the physician's office if additional information is needed. It also notes that the American Medical Association allows physicians to use this letter template in connection with their practices.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    These tools do not provide legal advice.

    Consultation with legal counsel may be appropriate


    to help identify and pursue claims that should be appealed. Visit the Private Sector
    Advocacy Web site at www.ama-assn.org/go/psa for additional information.

    Sample generic appeal letter

    [Date]
    Attn:____________
    Provider Appeals Department
    [Address]
    [City, State, ZIP Code]

    Re:____________________________
    Insured/Plan Member:____________________
    Health Insurer Identification Number:____________________
    Group Number:____________________
    Patient Name:____________________
    Claim Number:_________________

    Dear [Health insurer]:

    We are appealing your decision and request reconsideration of the attached claim that you
    denied on [date].

    We feel these charges should be allowed for the following reason(s):


    [insert reasons]

    Thank you for reviewing and reversing this claim denial. If you require any additional
    information, please contact [staff name] at [telephone number] between the hours of
    [insert time period that staff is available to answer calls, e.g., 8:00 a.m.–5:00 p.m.].

    Sincerely,

    [Physician]
    Or
    [Practice Manager]

    © 2008 American Medical Association. Permission is granted to physicians to use this letter
    in connection with their practices. Any other use is prohibited.

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