Writing A Medical Insurance Appeal Letter

Having healthcare insurance in place does not guarantee that every medical expense will be covered. Unfortunately, a lot of people find it surprising that even after paying their deductible, they are still left with some bills to pay because the insurance company has denied their claim. It is believed that 70% of claims that are denied were done in error, however, which is why it is so important that you look into this properly. If you are denied a claim, you need to appeal that decision. In fact, between 40% and 50% of all appeals are successful, so it is certainly worth trying it.

Before Writing a Medical Insurance Appeal Letter

The first thing you need to do is telephone the customer service department to find out why your claim was denied. It is possible that there is a simple error that can be resolved there and then. If not, then you do need to write an appeal letter, which has to follow the guidelines as stated in the policy. It is likely that you feel very angry and want to lash out at the claims adjuster. However, you should avoid that. Instead, try to maintain a professional and polite tone. Do not tell your insurance company to revise the decision, in other words. Instead, ask them if they could reconsider it.

Make sure that you truly understand your policy as well. There may be a time limit associated to when you can appeal a decision, so make sure to comply with that. Furthermore, you should find language in the policy that is on your side. Hence, make sure to highlight the elements of the policy that discuss appeals.

Content of the Appeal Letter

Make sure that your letter contains documented evidence supporting everything you say. For instance, you can include doctor’s notes and letters, radiology reports, medical records, and so on. Your letter should also include:

  1. Your name, policy number, identification details, and claim number
  2. The reason given for denying your claim, using their language
  3. A history of the medical condition and the treatments that were received
  4. Why you believe the denial was wrong, adding supporting information such as a doctor’s letter to confirm diagnosis
  5. All relevant dates, such as the date of the diagnosis, the date of treatment, and the date of the denial

Your letter should also explain what you would like the next steps to be. For instance, you may feel that the insurance company should compensate the bill in full. Do make sure that such is not done in a demanding tone, however.

Remember that you are writing a formal letter and it should be treated as such. It should not contain any grammar or spelling errors, and it has to be properly addressed. Ask someone to proofread it for you if possible. Also, keep photocopies of everything that you have sent, and send your letter via recorded mail. This gives you a paper trail to demonstrate that you have been proactive in resolving the situation. If you do not hear back from them after a week, make sure that you follow up.

Medical Insurance Appeal Letter Example

{Phone #}


Dear {representative}:

I was shocked and dismayed to receive notice on {date} that {insurance company} denied payment for {procedure}. I’ve received a bill from {physician/medical center} for {amount}. I cannot pay this.

Before consenting to {procedure}, I contacted your company to ensure that the doctor and facility were in-network. In an abundance of caution, I also obtained the “code” for the procedure. Nevertheless, the denial letter states that {procedure} was not covered due to {reason}.

This is egregious and unacceptable. I did my due diligence and now the entire financial wellbeing of my family, not to mention future heath care for {condition}, is in jeopardy.

Please take all necessary steps to rectify this error. It is causing my family great stress at a time that we should be focused on recovery.


{Sender Name}

Writing A Credit Card Hardship Program Letter

When people use their credit card, they do not do so with the intention of coming to a situation in which they cannot repay their debt. However, some things may happen that affect their finances. While it may be temping to do nothing and simply hope that the situation will resolve itself, the reality is that it usually won’t. Furthermore, credit card companies understand that people sometimes have difficulties and they would rather work with you to come to a solution, instead of having to engage in expensive recovery actions. Hence, if you find yourself in a situation of financial hardship, you should be proactive and contact the credit card company to come to a resolution.

How to Write a Credit Card Hardship Program Letter

There are numerous templates available that show an outline of the things that should be included in this type of letter. What sets the credit card hardship letter apart, however, is that it has to be seen as a stepped approach, rather than a single letter that you can write and send. Rather, you must be realistic and expect to write a series of letters that include the right things at the right time.

As such, you very first letter should be one in which you explain that you are in financial hardship and why. You should be professional, considerate, and polite. The credit card company is not interested in how your hardship is making you feel, but rather in facts. They want to know what has happened to you financially and how this has impacted your ability to repay your debts. You should also offer to pay between 15% and 25% of the outstanding balance of your credit card.

Importance of Honesty

Honesty is very important in these letters. Do not, for instance, eagerly offer to pay 50% of your balance, unless you are actually capable of doing this. Also remember that time is one your side. Older debts are notoriously difficult to recover, so it becomes more likely for a credit card company to agree to a deal.

Whatever your offer is, it has to be one that you can actually afford. This is why you must also include photocopies of all your proofs of income and of outgoings. Send bank statements, pay stubs, unemployment information, copies of expenses, investments, and so on. The credit card company will require all of that documentation and it is likely that they will also contact you for more.

Make Sure to Comply with the Agreed Upon Payment Scheme

If, after receiving your letter, the credit card company agrees that you are in hardship, they may offer you some sort of program. If so, make sure that you agree to their terms and conditions, and stick to them in full. If you miss any of the payments then agreed, or if you otherwise breach the agreed terms and conditions, you will have rendered it null and void. Remember that the credit card company is doing you a favor by offering an agreement in the first place, so do make sure that you stick to it.

Writing A Credit Card Hardship Program Letter Examples

{Phone #}


Dear {creditor}:

Please consider this letter my application for your hardship program.

I currently owe {amount} on account number {number}. My account is not yet delinquent.

Due to financial circumstances outside of my control, I am no longer able to make even the minimum monthly payment. {Explain hardship}. I am reaching out to you before my account is in arrears in the hopes of maintaining my good credit and avoiding late fees, a higher interest rate, and other penalties.

Please consider accepting monthly payments of {amount}. I would also appreciate it if my interest rate were lowered to {percentage}.

I am now {starting a new job/being treated for an illness/in a better living situation} and am confident that this rough patch will be over in a matter of a few months to a year.

I will be grateful if a revised payment plan is accepted. However, before moving forward with such a plan, please send a written copy of such and advise me as to how this might impact my credit rating in the future. I wish to avoid a negative credit report.


{Sender Name}

Writing A Hardship Letter Damage To Property

Sometimes, property damage can force you to become unable to pay your bills. For instance, with the recent hurricanes, Harvey and Irma, people have found themselves in significant financial difficulties. Insurance companies are slow to pay out, if they pay out at all, and some people have found that they have to replace virtually everything in their home. Many have also found themselves unable to work due to property damage at their place of work, which in turn means they are experiencing a financial hardship. In those cases, it may be possible to write a hardship letter, which is usually written to a mortgage company.

Tips on Writing a Hardship Letter Damage to Property

Your letter should be written formally. It should also be free from spelling and grammatical errors. Hence, make sure that you request someone to proofread your letter before sending it. In the letter, make it very clear what you are requesting specifically. This could be:

  1. Loan delinquency forgiveness
  2. Leniency in payments
  3. A full loan modification

Do also make sure that you indicate what is the financial product that you now have difficulty in paying. This could be a mortgage, but it could also be a car loan, a credit card, or any other financial product. Do also include your account number and personal details so that it is easy for the company to find you.

Avoid Being Emotional

You should then explain that you are currently experiencing financial hardship because of property damage. This is about being factual, not about being emotional. If you have experienced damage as a result of a hurricane, for instance, your creditor knows that you are going through difficulties. They are more interested in hearing how this hurricane has impacted your finances, not how you feel about it.

Be Clear as to What You Are Requesting

You should then make it clear what you are asking for specifically and for how long. If, for instance, you know that you will get back to work after several weeks, then you need to indicate this. If, on the other hand, you genuinely have no idea of how long the hardship will continue, then you must indicate that as well.

Describe the Damage to Your Property

Next, you have to explain the extent of the damage to your property. Make sure that the incident is dated, and that it is clear which property was damaged. Do also make it clear whether or not you have insurance and whether or not they have agreed to pay out on your bills and, if so, by how much. Document this as much as possible, including copies of the letters sent between you and your insurance company, photographic evidence, and so on.

Explain the Amount of Money Required for Repairs

Continue to explain that you currently require as much money as possible to repair or restore your property and that you will be unable to do so if you have to meet your financial obligations with the company you are writing to as well. It is of particular importance that you keep your creditor in the loop, showing how much you have been able to get ahead by not making payments so far.

Hardship Letter Damage To Property Example

Writing A Hardship Letter Medication Cost

Medication is incredibly expensive. And while proper health care has become more accessible since the Affordable Care Act, it still leaves a lot to be desired. Furthermore, with the new Trump Administration, there is a lot of uncertainty in terms of what is and isn’t covered. If you have been prescribed medication, it is possible that you will be in a situation where you cannot afford it. This is particularly true if the medication is a treatment for an illness that leaves you unable to work. If you experience financial hardship, you have the opportunity to write a letter to the drug representative about this, explaining your situation.

Tips for Writing a Hardship Letter Medication Cost

This type of letter is a formal request, so it should be written accordingly. This means that you should address it to the right department and the right person. Your letter should also be dated. In the subject line, explain that the letter is a hardship letter, referencing the name of the drug.

Starting the Letter

Make sure that your letter is straight to the point. Begin by explaining what you want – a percentage discount or even a free supply of a certain drug. State that you have been taking this medication for a specific condition and that it has significantly improved your quality of life. Explain the condition that you have, and what the medication is for. Also explain what would happen should you no longer be able to take the medication. Do also make sure you include information about the dosage and how often you need to take it.

Content of the Hardship Letter

It is very common for people to have to write a hardship letter medication cost after the price of medication goes up. If this is the case with you, make sure to include the date when the cost increased and what the old and new prices are. Explain that the price as it stands is no longer affordable for you, and why. Make sure you include documented evidence of this through a financial statement indicating your income and expenses. Attach pay stubs, Social Security benefit payments, bills, and so on.

Do also explain that you have tried to budget for the medication. Perhaps you have given up on social affairs, you have canceled a television subscription, or other things. Explain that you are still able to pay a certain amount if you are, and indicate that amount. However, be honest with that. It is better to offer nothing than to offer something that you cannot afford. You may also request, particularly if you do offer to pay something, for the price of the medication to no longer go up for you.

Ending the Letter

End the letter by thanking the manufacturer or supplier for their consideration. Keep the letter short and concise. Ideally, it should fit on a single page. Make sure to include photocopies of all your evidence, and that you take a copy of the letter for your own records as well. Lastly, send it through registered post.

Hardship Letter Medication Cost Example

{Your Name}
{Your Address}
{Your Phone #}


Dear {Drug Representative}:

I am writing to request a discount of {percentage} on {medication}.

For the last {amount of time} I have been on {medication}, which I require for {condition}. This is a life-threatening condition, and if I do not take this medication every {frequency}, {consequence} will occur.

As you know, {medication} increased in price from {price} to {price} over the course of {amount of time}. This price is one that I can no longer afford, as you can see from the {pay stubs, bank receipts} that I have attached to this letter.

I am still capable of paying {price} per {amount}, and I would like to ask that that price remain what I am charged.

Thank you for your time and consideration. Please feel free to contact me at {contact information}.

Thank you,

{Sender Name}