Can You Provide Me With A Sample Letter Of Appeal For Medicaid?

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Ian John Profile
Ian John answered
It is difficult to provide a sample letter that is universally applicable, as the wide variety of ailments, illnesses and disabilities suffered by people mean that in many cases, parts of any sample letter would be rendered pointless, or could possibly omit key information about the sufferer that would increase the chances of their appeal being successful.

Despite this, there are some easy to follow rules which will help when putting together a sample letter, which will allow you to formulate your own letter which clearly identifies the issues and why you are making the appeal.

  • Ensure that your letter is laid out correctly. You must include your name, address and phone number. You then need to ensure you include all the details of the claimant, including their name, insurance ID number, group number and claim number. Finally, complete the formalities of the letter by dating it and including the postal address of the insurer you are contacting.
  • Unless you know specifically who you are addressing the letter to, it is best to introduce the letter formally, by using 'Dear Sir/Madam,' or 'To Whom It May Concern:' to introduce the first paragraph.
  • The first paragraph should consist of a very brief introduction to the claimant, including their name, age and primary diagnosis. Once you have explained the condition, explain why the treatment that the insurance company has denied funding for is vital for the claimant to receive to enjoy a better standard of living.
  • Having introduced the condition and equipment and why it is needed in the first paragraph, go into the condition and equipment required in the second paragraph in more detail. List as many details about the ailments suffered and equipment used to alleviate it using as many medical terms as possible.
  • The third paragraph should be used to explain why this equipment will help the patient. Explain how it can alleviate their symptoms and improve their health, once again, try to convey a professional tone and use medical terminology to support your claims.
  • The fourth paragraph can be crucial to validating your appeal in that you should use it to state what would happen should the claimant not receive this assistance now. Demonstrate how this could lead to the patient making fresh claims in the future for a variety of complications and procedures, which could end up costing the insurance company considerably more. Again, keep the tone even and professional without being overly dramatic and emotional in your response.
  • It is a good idea to provide plenty of medical records and information to validate your claims with your appeal letter. If you have information and official documentation from health professionals to support your claim, it is a good idea to reference them here.
  • The penultimate paragraph should briefly summarize the treatment required by the patient and how often they are likely to need it.
  • Complete your letter with a single sign off, thanking them for considering your appeal and outlining that you are keen to hear their reply.
  • Check it, sign it and send it.

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