5 Sample Appeal Letters for Medical Claim Denials That are So Good You Should Write Home About Them

The term “denial” in the healthcare world has two meanings.

First, the obvious. It’s a psychological term often used to describe a natural defense mechanism in which we ignore feeling unpleasant. Second, it’s a term that’s best described as one of a medical organization’s worst nightmares. You see, the second meaning for denial in healthcare happens when an insurance organization doesn’t accept services rendered by a physician.

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In other words, a denial in the medical billing space means that you aren’t getting paid. Sure, you could say that I’m being a little melodramatic. After all, seasoned medical billing professionals will be the first to tell you that certain denials are less of something that you can avoid and more so an inevitability. They have a point.

Either way, they’re not called an “acceptance” by any means, so they’re still bad news. A recent study found that denial write-offs sit at an average of 53%.

A rate that high isn’t something that many organizations can afford, leaving smaller practices with a hard decision to make. If you’re faced with that scenario you really only have one option to pursue, submit appeal letters.

The first sample appeal letter I have for you is actually a template. Its whole purpose is time savings. Not only are you at a disadvantage already from a statistical standpoint when it comes to medical claim denials but also from a time perspective as well.

You see, the majority of doctors already state that they need at least 50% more time with patients. That statistic proves that facilities don’t have time. If these organizations had more time, they would allot it toward their clients. I don’t blame them… getting paid for a claim by an insurance provider helps keep the lights on, it doesn’t take precedence over client time.

So, if time is the leading factor as to why your organization doesn’t send appeal letters for your medical claim denials, what should you do? You need to make a template appeal letter.

This first sample appeal letter from Mt Home Arts and is exactly that, a template. Every time you receive a medical claim denial, there’s data you will always receive back, such as…Insurance Provider, Claim Adjustment Reason Code (CARC), and Date of denial

Now, that isn’t that much data but it’s all you’ll need because you already have all of the additional information available.

Plug in what comes back from the insurance organization and the information you already know into your appeal letter template…talk about a time saver

The second sample appeal letter places a heavy emphasis on branding.
For healthcare providers, branding is oftentimes an afterthought. I’m not trying to call you out if you fall within this majority, it goes back to what I stated earlier. Your number one priority is providing care for your clients.
Not to mention the fact that oftentimes a doctor’s name and title carries enough weight in most eyes to know that anything sent from them is important.

However, when it comes to sending appeal letters to insurance organizations…they’re all coming from medical facilities.

In other words, although being a doctor is a great achievement that leads to a certain level of respect, it’s not going to lend you any greater chances of your appeal letter having success.

All of this means that you need to figure out a way to make your letter stand out.

My third sample actually deals more with best practice…keep records and tracking information.

If you’re manually sending your appeal letters, you need to make sure that you’re keeping a record.

That record should not only include a copy of what you sent, but also when you sent it and when it reached the insurance payer. The last part of what I just said is what’s most important.

Whether you’re sending your appeal letter through the mail or electronically, it’s imperative that you have tracking information.
This is such an important piece of the puzzle because it gives you a timeline glimpse into the process involved with trying to appeal a denied claim.

The reality is that you may have to follow up multiple times with providers regarding your medical claim denials. But if you don’t keep records and/or don’t have tracking information on what you send, it makes the follow-up process much harder.

#ClaimDenials #AppealLetters

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Rejected claim can be appealed?

Actually I asked insurance to reprocess a rejected claim, but audit team gave an error to me .
Thy are asking me to appeal it.

How can a claim can be appealed without denial...? I think reprocess is the best way for rejection..
I kept rebutal on this to auditor


Kindly hlp me on this