Medicare Appeal Letter And The Example

When a doctor advises you to have surgery for a certain disease, and Medicare is not willing to pay for it, you can appeal it. If a cost protection denial is made, it could be due to things like incorrect coding by your doctor. Hence, you are recommended to file an appeal by writing a medicare appeal letter. You should understand several things related to the requirements for writing your letter.

Can I File An Appeal To Medical?

Anyone has the right to appeal to Medicare, as described by the Medicare Summary Notice (MSN). Under most circumstances, many of the plaintiffs won their appeal after they followed good procedures. The appeal letter that you will file must contain your name as the recipient, your health insurance number, the date of the service you took, the place of service, and your signature. Also, prepare a doctor’s letter who asked you to take medical action. Make sure that you send the letter to the correct address and department.

What Are The Tips To Write A Medical Appeal Letter?

Include a piece of evidence which states that your claim must be covered by Medicare. This can be a letter from your doctor or a certain health care provider confirming that your problem should be treated medically. Make sure you have a copy of or a record of the refusal made by Medicare, either orally or in writing.

The following is several tips to write a compelling appeal letter:

Write Several Basic Information

Writing your name, contact information, service, and rejection date, including the place of service, is the first step you should take. If there are important things that you must include, you can add them to make your letter look more convincing and formal.

Provide Evidence

The second step you need to do is attaching a letter from the health care provider, for example, if a doctor or health care provider makes a mistake such as a coding error.

Send Your letter

After you have made the revisions and are sure the letter is written properly, then send it to the correct address and department. Understand the policies, whether the letter should be sent in person or via email.

Medicare Appeal Letter Example

The following is a sample to write a short and clear Appeal Letter of Medicare:

Dear Mr. Frank,

I am writing to appeal the rejection of my claim number 765656567 for the date of service December 12, 2020. This is for the operation performed on me at XYZ Medical Center for the surgical removal of a cyst in my abdomen.

In my opinion, the reason for the refusal was due to an error code given by my doctor. I have attached proof of the statement and claim that has been corrected by my health service.  Therefore, I hope your availability to reconsider and pay my hospital bill as I am entitled to Medicare coverage.



Richard Parker

In conclusion, don’t hesitate to file an appeal if your claim is rejected by Medicare. You can write a good medical appeal letter to appeal gracefully.



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