All health insurance policies are clear on which types of surgery are covered and which are not. Those things that are classified as “elective surgery”, which means that they are optional rather than being life saving, are almost never covered by insurance companies. However, that does not mean that you might not be able to convince your insurance company to reconsider. This is particularly true if you believe that not having the surgery will cause significant financial hardship.
Guidelines for Writing a Hardship Letter to Insurance for Elective Surgery
This letter must be a formal one that is written in a professional style. It should be dated and addressed to the correct person. The subject line should indicate the reason for writing, and it should also show your policy number. The letter should also include other identifying information from yourself.
Starting the Letter
Your first paragraph should outline that you would like to request some leniency with regards to the policy. Specifically, you are requesting a modification of how the insurance company views the operation that you want to undergo. Explain that it is classed as “elective” according to their policies and procedures. However, you feel that the said operation is not elective but rather a necessity. For instance, if you do not have the surgery, you will be left unable to properly look after your family, have a significantly reduced quality of life, and/or become too sick to continue with your work.
Content of the Hardship Letter
Go on to explain that you understand why this particular procedure is usually classed as elective, stating that most people have it for non-medical reasons. State that your situation is different, however, because you have been suffering from a certain illness or condition for a certain amount of time (include the dates), and that you have tried all other types of available treatment (list them and when you had them). Explain that you believe that this particular operation will be your last chance at living a normal, comfortable life. State that you know the surgery is not guaranteed to be successful, but that not having the procedure will guarantee that you will have a poor quality of life.
These situations are highly emotive in nature. You are likely to feel quite desperate and to see the procedure as a last resort. Yet, it is vital that you remain factual at all times and don’t delve into feelings. It is far more poignant to have a statement from a physician who says that the surgery will greatly improve your quality of life, than for you to tell them that you feel depressed and worthless because of your condition.
Ending the Letter
Make sure that you can provide evidence for anything that you state in your letter. Include hospital appointment cards, medical notes, and doctors’ statements, for instance. Do also provide proof of the surgery having been successfully with other people in the same situation as you, even if that is abroad. Finally, make sure that you have appropriate costings for the procedures included in your letter as well.
Hardship Letter To Insurance For Elective Surgery Example
{Your Name}
{Your Address}
{Your Phone #}
{Date}
To Whom It May Concern:
I am writing this letter to request leniency concerning my insurance policy’s approach to {medical operation}. It is listed as an “elective surgery” and therefore not permissible for coverage according to my current policy. However, if I do not get this operation, I will be {too sick to work/in horrible pain/disabled/unable to care for my family, etc.}
{Medical operation} is considered an elective surgery most of the time because it is mostly used for {reason}. I have been sick for {amount of time} with {illness/injury} and I have already tried {alternative one} and {alternative two}. {Medical operation} is my last chance at {recovery option}. Although it is not a guarantee of success, it has a higher chance of helping my condition than anything else available to me. If it is not covered by my insurance, then {brief description of repercussions}.
I am attaching a doctor’s note outlining my situation and the important nature of this surgery in my particular case. Thank you for your consideration and understanding.
Thank you,
{Sender Name}