What should I put in my appeal for an insurance claim denial?

Appeals require some combination of these essential elements:

• Initial evaluation for a plan of care and measurable goals
• Progress report
• Prescription with diagnosis, frequency of service, session length, and treatment duration
• Office visit or daily treatment notes
• Letter of medical necessity from your child’s therapist or physician
• Summarizing cover letter

Offer the writing physician a letter template with a header containing all the relevant plan information, ID number, and any group number with a list of points that you would like made. Include a copy of the denial or the report of the service provider treating your child. Give your therapist or physician ample time to generate the needed documentation.

For more tips about dealing with insurance claim denials, see our article Insurance Claim Denials and Appeals 101.