Sample Cover Letter for Network-Level Reimbursement

Health plans typically make deep cuts in reimbursement when members access out-of-network benefits. Sometimes, the family’s decision to seek out-of-network care is based on the preference for one provider over others; this does not easily qualify for an authorization request. Other times, the decision is based on the health plan’s actual lack of access to an available contracted provider within a reasonable geographic distance or the lack of required specialization. The lack of appropriate care is a circumstance in which a request for increased reimbursement is more suitable.

This cover letter template is a fillable draft letter to the plan in order to make your appeal for access to care. Make a copy of this Google doc to help you draft your cover letter.

For help requesting in-network-level reimbursement for an out-of-network provider, see our step-by-step walkthrough.