Effectively communicating with patients about insurance matters is essential for any healthcare provider. Whether you need to notify patients about policy changes or explain an insurance denial, a clear letter is crucial. Similarly, patients often need help drafting a letter requesting coverage or appealing a denial.
These sample letters provide templates for various scenarios, from routine notifications to more complex situations like an insurance denial appeal. Using a structured format ensures your message is professional and easily understood by patients and insurance companies alike.
Sample Letter to Patient Regarding Insurance
[Your Clinic/Hospital’s Name]
[Your Clinic/Hospital’s Address]
[City, State, Zip Code]
[Phone Number]
[Website]
[Date]
[Patient’s Full Name]
[Patient’s Address]
[City, State, Zip Code]
Re: Important Information Regarding Your Insurance Coverage
Dear [Patient’s Name],
This letter is to inform you about a recent update regarding your health insurance plan, [Insurance Company Name], and the services we provide at [Clinic/Hospital’s Name].
We are writing to confirm [e.g., that we are still in-network with your plan, that a specific service requires pre-authorization, a change in our billing process, etc.]. We want to ensure you have all the necessary information to continue receiving care without interruption.
We recommend contacting your insurance provider directly at the number on your card to verify your benefits and coverage for any upcoming appointments or procedures.
If you have any questions for us, please don’t hesitate to call our billing office at [Billing Office Phone Number].
Sincerely,
[Your Name/Billing Department]
[Your Title]
[Clinic/Hospital’s Name]
Sample Letter to Notify Patients
Subject: Important Update: Changes to Accepted Insurance Plans
Dear Patient,
This letter is to formally notify you of a change in the insurance plans accepted at our practice, effective [Effective Date]. As of this date, [Explain the change, e.g., “we will no longer be in-network with XYZ Insurance” or “we are pleased to announce we now accept ABC Insurance”].
We are committed to making this transition as smooth as possible. Please contact our office to discuss your options or visit our website for a complete list of our in-network providers.
Sample Letter Requesting Insurance Coverage
Subject: Request for Pre-Authorization for [Medical Service/Procedure]
Dear [Insurance Company Name] Claims Department,
I am writing to formally request pre-authorization for [Medical Service/Procedure] as recommended by my physician, Dr. [Doctor’s Name]. My policy number is [Your Policy Number].
My doctor has determined that this procedure is medically necessary for my condition, [Your Diagnosis]. I have attached a letter from Dr. [Doctor’s Name] detailing the medical necessity and the relevant treatment codes.
Please review the enclosed documentation and approve coverage for this service.
Insurance Denial Letter to Patient Sample
Subject: Explanation of Insurance Denial for Recent Service
Dear [Patient’s Name],
We are writing to inform you that your insurance provider, [Insurance Company Name], has denied coverage for the service you received on [Date of Service].
According to the explanation of benefits we received, the reason for the denial is: “[Reason for Denial, e.g., ‘Service not deemed medically necessary,’ ‘Out-of-network provider’].” You will be responsible for the balance of $[Amount]. We have attached a copy of the denial from your insurer for your records.
We recommend you contact your insurance company directly to discuss this decision.
Sample Insurance Denial Appeal Letter
Subject: Appeal of Denied Claim for [Service/Procedure] – Claim #[Claim Number]
To Whom It May Concern:
I am writing to formally appeal the denial of my claim [Claim Number] for [Service/Procedure] received on [Date of Service]. My insurance plan denied this claim, stating that [Reason for Denial].
I believe this denial was incorrect. This service was medically necessary for the treatment of [Your Diagnosis], as prescribed by my physician, Dr. [Doctor’s Name]. I have enclosed a letter from my physician detailing the medical necessity, my medical records related to this condition, and any other supporting documents.
Please reconsider your decision and approve this claim.
Related: