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This decision by [NAME] was difficult but also a major breakthrough/ necessity for [his/her] treatment. Obtain and insert the name of a person to whom you’ll address the letter — avoid sending to a generic title or “To Whom It May Concern.”, Admission Date – Discharge Date [condition], List each issue and its medical consequence [e.g., secondary amenorrhea since DATE, which has the potential to cause irreversible bone damage leading to osteoporosis in his/her early adult life. In summary, [PATIENT NAME] intended to be a full-time student this fall until [his/her] treatment team suggested otherwise in the early August. Respected Sir, We are proud to be a strategic business partner with an esteemed organization like Mug Heat Wraper. We have been following [patient name] in our program since [DATE]. Thank you in advance for your cooperation. The insurance company only knows the information you supply, so be specific and provide support from the treatment team! To whom it may concern, I am writing this letter to request for the approval of expense coverage of my back surgery, which I recently went through on 5 th July 2019.. After reviewing my policy details, as a member of ABC Insurance Ltd (Member ID: XXX), I believe I am entitled to the coverage of any sort of expenses associated with my medical … Enclosed with this letter are the medical test details, bills, and other supporting documents for your reference and review. I am currently following up on your instructions and appreciate your assistance in explaining what to do. We recommend a minimum 60- to 90- day stay in a tiered program that offers: intensive residential and transitional components focusing on adolescents and young adults with eating disorders (not older patients). The policy number is [123456789]. Sample Appeal Letter for Services Denied as 'Not a Covered Benefit' As someone with cancer or a caregiver for someone with cancer, you have a lot on your mind without having to worry about payments and insurance. [NAME] has been receiving coverage from [INSURANCE COMPANY] for treatment of serious medical issues since [DATE]. Follow-up letter to enrollment department after coverage was terminated retroactive to June 1st by the insurance company’s computer. Relationship Manager. For this reason, it is a good idea for the consumer to mention that they are not happy with the cost of their present insurance coverage and are looking for a better price. Follow up letters with phone calls and document whom you speak to. co. employee) (Name of Insurance Co.) An insurance document covers areas such as insurance coverage and its benefits. Make sure to include the death certificate, as well. I’d be happy to answer any further questions and can be reached at: [PHONE]. I thank you for your letter dated 10th April, 200X. At the end of the spring semester [PATIENT NAME’S] medical issues intensified and [PATIENT NAME] returned home for the summer. 2, & several local options full and part-time] needed to be up for discussion to meet [patient name’s] medical needs. A helpful collection of suggested forms, letters, and wordings for insurance professionals. You may need to write a letter to an insurance company requesting money when you have a claim. At the end of the semester I met with my [son/ daughter] and [his/her] therapist to make plans for treatment over the summer. To: [NAME OF INSURANCE COMPANY MEDICAL DIRECTOR]: We are writing this letter to summarize our treatment recommendations for [patient name]. At one point payment for one of [his/her] medications was denied even though the treatment team recommended it, and it was prescribed by [his/her] primary care physician, Dr. [NAME]. When comparing insurance quotes, there is no point in comparing two different levels of coverage. I am enclosing a copy of the APA guidelines and have noted [PATIENT NAME’S] current status. Period of insurance. Examples of such programs would include [name facilities]. Your current issue or rejection can be a computer generated “glitch.”. Title: Sample Letter for Requesting Copies of Claim-Related Documents Author: Emily Cabral Created Date: 3/21/2016 10:44:01 PM Sample Insurance Approval Request Letter. INS. For example, a person who doesn’t have a swimming pool doesn’t need coverage for accidents in the pool area. I am enclosing the bills we paid for those initial visits for reimbursement. Here it is. I would like this decision to be reconsidered because [insert PATIENT NAME] continues to meet the American Psychiatric Association’s clinical practice guidelines criteria for Residential treatment/Partial hospitalization. DATE. Jennifer Smith 1324 Accolade Avenue APT 22 New York, NY 10022. At that time I began notifying the insurance company. I am writing you this letter to claim reimbursement for the medical tests that I had last week. I have three rooms in the building including an office, display shop and large area for making and storing the clay pots and decorations. Your Name Your Address City, State, Zip Code. It appears that I am being charged a copay for [his/her] treatment as a mental health service when in reality [he/she] provides [PATIENT NAME] with pharmacologic management for [his/her] neuro-bio-chemical disorder. Insurance Administrator’s Name Insurance Company’s Name Insurance Company’s Address City, State, Zip Code. The main purpose of the letter is to encourage the insurance company to sell their product at a good price. Request that the copay for the psychiatrist from the patient be changed to a medical copay rate instead of the higher mental health copay, because the psychiatrist was providing medication management, not psychotherapy. 1, UNIV. In this case, after contacting their local association for eating disorders experts, the family that created this letter realized that no qualified medical experts were in their area to diagnose and make recommendations for their child. In order to make these points clear, we have produced many typical insurance letters which will carry the basics of Insurance Letters. My [son/daughter] has been under treatment for [name the eating disorder and any applicable co-existing condition] since [month/year]. Since continuity of care was imperative, we went ahead with the process and lost sight of the preapproval needed from [INS. [He/she] was accepted at [UNIVERSITY 2 NAME] and attended the [DATE] semester. Letter from doctor describing any medical complications your child has had, the doctor’s recommendations for treatment, and the doctor’s prediction of outcome if this treatment is not received. Further research and documentation was required to seek reimbursement for the treatment facility portion. [Patient name’s] malnutrition is damaging more than [his/her] heart. [Dr. NAME] is sending you a letter that should arrive very soon about [PATIENT NAME’s] medical status that required [him/her] to reduce the number of classes [he/she] will be able to take this fall. We do not recommend treatment in a non-eating disorder-specific behavioral treatment center. An insurance proposal is a document prepared by the insurance company for its customers. CO. NAME & ADDRESS. Don’t panic! Date May 1, 2018. Please feel free to get answers to any questions regarding these plans from [PATIENT NAME’S academic advisor Mr./Ms. California, CA 1001. In my research to identify someone experienced in eating disorder evaluation and treatment, I discovered that [insert Dr.NAME at HOSPITAL in LOCATION] was the appropriate person to contact to expedite plans for our child. At this time, I would like you to put in writing to me and to my child’s case file that [INS. All but the Request for Service form are available as Word docs. If you have any questions, please speak to [employee name]. However, the cooperation of the fine staff at [INSURANCE COMPANY NAME] makes it a little easier. EMPLOYEE NAME] communicated to me that I needed to have my child’s primary care physician write a letter supporting these plans. Remember: you need to research the professionals available through your plan and local support systems. A health insurance claim letter may be required if an individual’s doctor or other healthcare provider did not submit the required documents for a claim to the individual’s health insurance company The patient has the right to any healthcare benefits they pay for or get through their job. DOB (Date of Birth) Insurance ID# Case # Dear [NAME]: Cc: [CASE MANAGER, MENTAL HEALTH CLINICAL DIRECTOR, MEDICAL DIRECTOR]. After a workable plan was made, I called the enrollment department at [INS. Outcome: Adjustments can be made so that the family is billed for the medical copay. As you can imagine, this was all very stressful for the entire family. There is a kiln in the pot making area. 2]; 3) a copy of [PATIENT NAME’S] apartment lease for the year; and 4) [his/her] recent letter to [UNIV. Note: When a student does not register on time at the primary university at which he/she has been enrolled, insurance is automatically terminated at that time. When creating a formal or service letter, discussion design as well as format is essential to earning a great initial impression. The need to flex hospital days for counseling sessions. Outcome: 10 Hospital days were converted to 40 counseling sessions. Now, a letter of Interest with respect to credentialing should be sent keeping specific requirements in mind. I am attaching 1) my previous enrollment notification note; 2) [PATIENT NAME’s] acceptance from [UNIV. Statistics & Research on Eating Disorders, Getting Insurance Approval: Arguments to Support Your Claim, Sample Letters to Use with Insurance Companies. CO.]. Residential placement services for eating disorder treatment have been denied for our [son/daughter] against the recommendations of a qualified team of experts consistent with the American Psychiatric Association’s evidence-based clinical practice guidelines. You can easily adapt the basic letter format to create your own effective demand letter. Send the letter by USPS certified mail, return receipt requested to confirm the date the insurance company receives the letter. Thank you in advance for your cooperation and prompt attention to this matter. At the beginning of August [PATIENT NAME] and the treatment team members began to discuss [PATIENT NAME’s] needs for the fall semester of [YEAR]. Insurance has expanded into various branches such as health insurance, business insurance, travel insurance and what not. Get a signed delivery receipt – especially when time is of the essence. To: NAME OF CONTACT PERSON. White blood cell count and serum protein and albumin levels have been steadily decreasing as well, because of extraordinarily poor nutritional intake. A cover letter is what you send before applying for a job at a specific point of time, whereas a letter of interest can be submitted at any time. Cc: [CASE MANAGER, NATIONAL MEDICAL DIRECTOR (get the names for both the medical and behavioral health divisions), NATIONAL MEDICAL DIRECTOR – Behavioral Health]. [He/she] was first seen at the college health clinic at [UNIVERSITY NAME] and then referred for counseling that was arranged through [INS. In [DATE], [ PATIENT NAME] requested a temporary leave of absence from [UNIVERSITY 1 NAME] to study at [UNIVERSITY 2 NAME] for one year. Outcome: Reimbursement was provided for the evaluating/treating psychiatrist visits and medications. January 21, 2019. Dr. [NAME] was willing to see [him/her] immediately, so we made those arrangements. Thank you for your assistance. Writing a Loan Request Letter to Employer [with Sample], Writing a Request Letter for Training Course [with Sample], Writing a Guest Speaker Request Letter (with Sample), Writing a Shift Change Request Letter [with Samples], Writing a Letter Requesting Financial Assistance for Education [with Sample], How To Appeal A Health Insurance Decision, 7 Terrific Tips For Handling Your Own Auto Accident Case, Writing an Auto Insurance Cancellation Letter (with Samples), Writing a Strong Insurance Claim Letter for Car Accident, Writing a Counter Offer Letter for Insurance Settlement, The kiln has been certified safe by the local fire department, The shop is on high ground, so flood damage, if any, would be minimal, The shopping center has had no break-in for the past seven years. The letter should include the basic facts. Use this letter to request a complete copy of your homeowners’ policy from your insurance company. I would consider working with you to … Therefore, although [he/she] chooses to receive services from an outpatient team, [he/she] requires an intensive level of support from that team, including ongoing counseling, to minimally meet [his/her] needs. [His/Her] course has been complicated by the following medical issues: Despite receiving intensive outpatient medical, nutritional and psychiatric treatment, [patient name’s] medical condition has continued to deteriorate with [describe symptoms/signs, e.g., consistent weight loss since DATE] and is currently 83% of [his/her] estimated minimal ideal body weight (the weight where the nutritionist estimates [he/she] will regain regular menses). I’d like to share my process and give suggestions to helping you increase your clinicians’ income and your bottom line. Keep in mind that a cordial, business communication tone is essential. We spoke the other day regarding my [son’s/daughter’s] enrollment status. Start date of insurance cover. I ask that you immediately reinstate [him/her] as a policy member. Letter to a managed care plan to seek reimbursement for services that the patient received when time was insufficient to obtain pre-authorization because of the serious nature of the illness and the need to deal with it urgently. Dear Sir, I can be reached at 555-123-4567 or a name@email.com, Your SignatureYour Name PrintedName of BusinessOwnerList of Enclosures. Outcome: The student was immediately reinstated as a less than full-time student. We hope you can find what you need here. We understand that in the past, your case reviewers have denied [patient] this level of care. Sample Letter for Insurance Approval for Electric Wheelchair. Keep in mind that you need to seek a qualified expert, and not a world-famous expert. Sample 1 – Health Insurance Claim Letter Sample. Full documentation of our child’s grave medical condition and history and our attempts to obtain coverage for that care is available from our case manager [name]. There are five employees along with myself, the owner. Writing an Insurance Quote Request Letter [with Sample] Make A List. Unfortunately, some insurance companies may reject claims for certain health services. This letter is in response to [insurance company name’s] denial of continued counseling sessions for my [daughter/son]. [He/she] has worked with [his/her] [UNIV. My business is a pottery shop that sells handmade pottery and home décor. If you have further questions you may contact me at: [PHONE#] or [Dr. NAME] at: [PHONE#]. I realize there are numerous agents you might have chosen so I greatly appreciate the opportunity to fulfill your insurance needs. Make sure you provide very specific information from your research. If [his/her] status is not resolved immediately it will generate a GREAT DEAL of unnecessary extra work for all parties involved and, quite frankly, I’m not sure that our family can tolerate the useless labor when our energy is so depleted and needed for the medical/life issues at hand. It will be good to write the actual name of the insurance product in … NAME], whom [PATIENT NAME] has given written permission in a signed release to speak to you. Automatic termination can cause an enormous amount of paperwork if not rectified IMMMEDIATELY. [He/she] was first seen at the college health clinic at [UNIVERSITY NAME] and then referred for counseling that was arranged through [INS. Sample Car Accident Demand Letter. The first letter informs the insurance company of the student’s current enrollment status in a timely fashion, and the second letter responds to the abrupt and retroactive termination. Dear Mr. Bradley, Kindly receive this letter as an official request to terminate my insurance policy referenced LF500500. CO.] Medical Director [PHONE #]. Purpose of Claim letter Claim letter is written to inform the insurance company about the incident explaining how it happened and also providing details about the situation. Here’s an example of a personal injury demand made by a fictional car accident victim. When writing an insurance quote request letter to different insurance companies, the consumer needs to be sure that the different companies are giving quotes for the same coverage, limits and deductibles. CO.]. Sample Letter #5. I want you to make money. When comparing insurance quotes, there is no point in comparing two different levels of coverage. A certificate of insurance is the way for you to demonstrate and show another party that you have insurance that will cover you for certain types of losses. It is recommended to get quotes from at least three different companies. We believe that without intensive treatment in a residential program, [patient name’s and condition], and the medical complications that it causes, will continue to worsen causing [him/her] to be at significant risk of developing lifelong anorexia nervosa or dying of the disease. Sample Appeal Letter B. INS. Dear [insert name]: My [son/daughter] has been under treatment for [name the eating disorder and any applicable co-existing condition] since [month/year]. This is the only appropriate and medically responsible care plan that we can recommend. REQUEST FOR RATE INCREASE. [INS. Our Insurance Agent, Mr. R.K. Dhawan, wIll call on you on 18th April, 200X at 8.00 A.M. Yours Faithfully, ……………………… For taking a loan against an Insurance Policy. This letter is forthcoming as we speak. When you pay for insurance coverage, you expect to get monetary benefits in the event of certain situations such as accidents or illness. Sample Letter Requesting Certificate Of Liability Insurance. It was coming from reputable online resource and that we like it. I spoke to a [INS. A certificate of liability insurance is usually mandated when you are an independent contractor for an organization and it shows the amount of the coverage, the insurance company … – This can help the receiver to send your letter to respective department for further processing. Home Phone: (212) 555-9252 Cell Phone: (212) 555-9513 E-Mail: smithjen1999@hotmail.com. We truly believe that to offer a lesser level of care is medically negligent. I first spoke to [PATIENT NAME’S] primary physician and then contacted the local eating disorders support group. Thank You ForYour Inquiry Letter. Type of the policy (Motor, Fire, Health etc.) [PATIENT NAME] was consequently placed in a residential setting in the [LOCATION] area and continues to see Dr. [NAME] through arrangements made by [INS. Keep the body between 2-3 paragraphs.] As far as our family was concerned, all options [UNIV. We always effort to reveal a picture with high resolution or with perfect images. CO.] is taking complete responsibility for my [son’s/daughter’s] life. Remember, just because you are using outpatient services does not mean that you cannot take advantage of benefits for a more acute level of care if your child is eligible for that level of care. BI MS 3259. It is recommended to send letters to the large insurance companies as well as a few small or independent companies. Either I or one of my employees will be here Monday – Saturday, from 9am – 6pm, and we would appreciate it if you would call before coming. If it is a request for home or office building insurance, the type of coverage should be mentioned such as fire, flood or theft. Cc: [list the people in the company you are sending copies to]. The request letter should be courteous, clear and to the point. Some insurance companies may add extra coverage that the consumer doesn’t need. Dear [Name of Administrator]: This letter is to formally request reimbursement for medical expenses for policy [NUMBER]. CO. NAME & ADDRESS (use the headquarters). As soon as [PATIENT NAME’s] fall classes are finalized on [date]’ that information will also be sent to you. This includes the amount of time the policy spans such as for one year or six months. Remember, the psychiatrist must use the proper billing code. Such a tiered program could provide the intensive residential treatment that [he/she] so desperately needs so [he/she] can show that [he/she] can maintain any progress in a transitional setting. The consumer can also enclose a copy of their current insurance policy and ask the insurance company if they can give the same coverage for a lower premium. Claim letter is the most important and the basic requirement to ensure a person’s eligibility for claim from the company or organization. DATE. No qualified expert emerged quickly from the community of our [INS. It should be made easy for them to reach the consumer with phone numbers, email addresses and the times they are available. Given this history, prior levels of outpatient care that have failed, and [his/her] current grave medical condition, we recommend that [patient name] urgently receive more intensive psychiatric and nutritional treatment that can be delivered only in a residential treatment program specializing in eating disorders. As you can imagine, this process is very emotionally draining on the entire family. Re: PATIENT’S NAME. These sample letters can be used in various circumstances you may encounter that require you to communicate with insurance companies. Home Country Insurance Rebecca Archer – Senior Claims Adjuster 1915 Central Park Avenue Yonkers, NY 10710. A sample letter to send to life insurance company by a beneficiary of the life insurance policy. During these past [NUMBER years], [patient name] has had [NUMBER] hospitalizations for medical complications of [insert conditions, e.g., malnutrition, profound bradycardia, hypothermia, orthostasis]. Sample Letter of Appeal For Gastric Bypass Surgery. Also, at the beginning of [his/her] placement, some confusion existed about medications necessary for [PATIENT NAME] during this difficult/acute care period. When [he/she] completes re-enrollment at [UNIVERSITY NAME] (which is not possible to do until the first day of classes, [DATE]), [he/she] will have the registrar’s office notify you of her status. “Discussion” with the insurance company about residential placement when the insurance company suggests that the patient needs to fail at lower levels of care before being eligible for residential treatment. Of paperwork if not rectified IMMMEDIATELY guidelines and have noted [ PATIENT ]! To helping you increase your clinicians ’ income and your bottom line CompanyCity. 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