There are various reasons as to why an insurance company may deny coverage. Whatever those reasons are, however, the impact can be significant for an individual. This denial often becomes a cause for new hardship, particularly in cases of medical bills. There usually is no opportunity to decide whether or not to have treatment before speaking to an insurance company, which means you could be left with significant bills to pay. If this is the case, you may want to consider writing a hardship letter to appeal the decision.
Basics of Writing a Hardship Letter for When Insurance Denied Coverage
This type of letter is a formal letter and should be treated as such. It should be properly formatted, therefore, and addressed to the right person in the right department. Contact the insurance company to determine to whom you should write to if you’re not sure. The letter should be short and to the point, preferably fitting on a single page. It should also be proofread, so that it does not contain any grammatical or spelling errors.
Starting the Letter
Your first paragraph should explain what has happened. For instance, you may have had an operation. Indicate the date when this occurred and why it was needed. You should then specify when you were told and by whom that your request for insurance coverage was declined. You should, at the point, have been given a reason, which usually is that the company does not feel the treatment was “medically necessary”. Whatever the reason that was given to you, include that in the letter as well.
Content of the Hardship Letter
You should then explain that you wish for the case to be reconsidered and why. For instance, you may have been in hardship which stopped you from seeking medical treatment in any other way. Alternatively, you may have additional evidence that demonstrates that the treatment was necessary, in which case you should also explain what the consequences would have been should you not have accessed the treatment. It is also possible that the denial of coverage now causes you financial hardship. Whatever it is, you must provide documented evidence and facts for all your statements.
There is one exception to this matter. If you feel the decision is completely wrong, then you can appeal it. However, that is different from writing a hardship letter, which essentially states that the decision made by the company is correct, but you would like them to make an exception in your particular case. If you want to appeal a decision, you are likely to have to follow different policies and procedures. Your insurance company should be able to provide you with details on what those steps are and how to get the ball rolling.
Ending the Letter
End your letter by respectfully requesting that the insurance company reevaluate your case. Unfortunately, the insurance company has no obligation to actually do so. Hence, you do have to make sure that you write your letter in a respectful manner and one that does not accuse the insurance company of anything.
Hardship Letter For When Insurance Denied Coverage Example
{Your Name}
{Your Address}
{Your Phone #}
{Your Account #}
{Date}
To Whom It May Concern:
On {date}, I required {brief but specific description of medical transportation, operation, etc.} due to {medical emergency}. I was notified on {date} from {insurance company representative} that my request to have {percentage} of the cost covered by my insurance was denied because the {operation/transportation/etc.} was not medically necessary.
I request reconsideration in this case. Due to {hardship}, I was unable to seek out {medical alternative}. This {action} was my only option and therefore was completely medically necessary. If I had not sought out this action, I would have {medical consequence}.
In light of these circumstances, I respectfully ask for a reevaluation of my case. I have attached {a doctor’s note, medical records, financial stubs, etc.} to substantiate my claim. Thank you for your consideration.
Thank you,
{Sender Name}