Appeal Writing Guide – Medical Necessity

Health insurance companies might deny payment for a medical service for any number of reasons.  One common reason is medical necessity, which basically means that the insurer believes that the treatment is not medically appropriate for this patient.  People can appeal medical necessity denials.

This article includes some materials to help people write effective appeals following a medical necessity denial:

1. A simple guide to writing appeals; and
2. A template (fill-in-the-blank) appeal letter.

To win a medically necessity appeal, it is very important to have support from a doctor or other healthcare provider.  The issues in dispute in these case are medical in nature, so it’s very helpful to have a letter from a medical expert who is knowledgeable about the treatment in question and knowledgeable about the patient’s condition.

This article includes some additional materials to make it easier to gather these letters of support:

1. A template (fill-in-the-blank) letter of support to be used by a doctor or other healthcare provider; and
2. A tip sheet to help doctors and healthcare providers write strong letters of support.