Denial Appeal Template

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If an insurer has a denied payment for a patient, this template provides the information needed to submit an appeal for payment to the insurer.

If an insurer has a denied payment for a patient, this template provides the information needed to submit an appeal for payment to the insurer.

Letter Sample:

Attached is supporting documentation, including [List of Attachments], which provide additional details to support this appeal.

It is expected that this claim be reviewed and reconsidered within 14 days of receipt. If any further information is needed, feel free to contact me at the details provided above.