Insurance Reimbursement Appeal Letter Sample

photoThis letter is my formal appeal of the rejection of Claim Number _____ for Lactation Consultation Services provided to my son, (Name) on (Date) for the amount of _____.

Summary of Events: Child was born on (Date). He was discharged from the hospital on (Date) (Detail here whatever complications you had with feeding/jaundice/dehydration/re-admittance to hospital, etc) On (Date) we met with our pediatrician, (Name) and expressed concerns about breastfeeding. Dr. _______ noted that baby was struggling to thrive and referred us to Lactation Consultant, Renee Beebe, M.Ed., IBCLC. Renee provided her services on (Date). Following the consultation, I submitted all required paperwork to (name of insurance company) for reimbursement. On (Date), I received an Explanation of Benefits (referenced above), noting the claim was denied. Continue reading