Insurance appeal letters assignment

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Insurance appeal letters assignment

Your office has received a series of claim denials from one particular insurance carrier and you do not agree with the decision. You should consider appealing the denial. Go back and review the patient’s insurance card and verification form for coverage information. The explanation of benefits (EOB) letter from the health plan is the key to payment or denial status. If the coverage language supports payment, write an appeal letter describing the disorder and its medical nature, and reference the coverage policy paragraph that shows how your treatment fits coverage criteria. You may have to investigate coverage on the insurance website.

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Insurance Verification Information
Doctor Williston C A Initials Verified on
Patient # 22534 Computer # 7153 Case type
Patient Name Mr. Michael West D O B 7/5/1977
Insured’s name Self D O B
Relationship Self Since (Date) Injured / ill since
Employer Target Phone 8042231451
Address 11105 West Broad Street Supervisor Jeffery Richards
City Glen Allen State VA Zip 23623 Note
Insurance Company Aetna Phone 8043308340
Address 9030 Stony Point Pkwy Insured’s ID
City Richmond State VA Zip 23225 Group # 145671
Contact Mr. George Title Claims Assoc Phone 8043308340 Claim # 49349-399-39A
Notes PPO
Primary or Secondary insurance Aetna, no secondary
Diagnosis Allergic contact dermatitis
Treatment prescribed triamcinolone acetonide topical ointment; follow up two weeks
Policy effective from
Deductible amount per year
Deductible met?
Max payment for initial visit
Max payment covered per visit
Max ceiling for X-ray and other diagnostics
Max number of visits covered per year
Items expressly not covered
Items requiring specific tests & confirmation
Other notes and comments

Insurance appeal letters assignment