Sample Appeals Letters to Medical Insurance Carriers This intel on filing medical billing claims is intended to help medical billing professionals and is not intended for patients or the general public.
These are some appeals letters that show some mistakes that can be made in medical billing and how they can be successfully appealed.'
This is a sample appeals letter.
Acme Anesthesiologist
P.O. Box 270
Massapequa Park, NY 11762
POMCO
Att: Appeals Department
P.O. Box 6329
Syracuse, NY 13217
Dear Provider Appeals Department,
I am sending you an appeal on the patient’s behalf because Medicare crossed payment to Tricare automatically so they paid even before we received the Medicare payment on 1-26-10.
Tricare sent us a refund notice on 3-26-10, when we found out the patient had you as a secondary we then filed. Please take this circumstance into consideration, thank you very much for your time and consideration on the patient’s behalf.
Sincerely,
Angel Bean
Claims Correspondent
This letter could be made even better by putting our in-house account number, their account number, the claim number directly beneath the carrier’s address.
This is a letter to the insurance company for a level two appeal for payment.
Healthy Medical Associates
P.O. Box 220
Islip, NY 11751
Healthcare Partners, IPA
1225 Franklin Avenue
Garden City, NY 11530
SUBJECT: LEVEL 2 APPEAL
ATTENTION: Provider Appeals Department
Dear Appeals Department,
This is to inform you that on 3-13-10, you accepted an electronic claim, you therefore interpreted the code that came through as 0181- instead of 01810.
We called and tried to have this matter resolved, however we are now being persecuted for timely filing, which we think is unfair due to the fact that code came through as one digit off.
Please review corresponding screen notes as documentation of our efforts in this matter to have this claim reconsidered.
Thank you for your kind cooperation.
Sincerely,
AngelBean
Claims Correspondent
This is a letter you would send when the insurance company claims that they don't have the appeal on file.
In regards to: ID# 10012345
Brooklyn Anesthesia
P.O. Box 220
Islip, NY 11751
Elderplan
Attention: Apeals Department
P.O. Box 199100
Brooklyn, NY 11219
Dear Elderplan:
Subject:Mr. Giovanni Zepetelli
Acct# HD 1192
Date of Service: 2/21/10
I am sending this correspondence to Elderplan in response to your statement that you do not have the
3/8/10 appeal on file. Dr. Sanjay Bakh administered the anesthesia necessary for the patient, code 00142 – the Anesthesia was started at 8:00 a.m. and went until 9:10 a.m. - which makes the time for the claim a basic value of 6 + time 5 = 11 units. 11 units multiplied by $19.73 is $217.03. However, Elderplan only paid $177.57 not the correct medicare rate of $217.03.
Please review this claim and adjust accordingly for payment to the anesthesiologist.
Thank you for your consideration in advance.
Sincerely,
AngelBean
Claims Correspondent
This is an appeals letter that gives information about why the payment amount was wrong.
BAMBI Medical Associates
P.O. Box 220
Islip, NY 11751
OXFORD
Attn: Provider Appeals
P.O. Box 7081
Bridgeport, CT 06601-7081
Re: Eva Yasur
Id# 185325402
Date of Service: 3-13-10 – Charges $660.00
Dear Provider Appeals Department,
I am sending this correspondence in response to a denial of our claim as part of a global procedure.
Dr. Karen Di Lello administered the anesthesia necessary for the patient, code 01991 – the anesthesia was started at 8:00 a.m. and went until 8:35 a.m. - which makes the time = 3 units + BV or base value
= 3 + ASA modifier = 1 = 7 total. This shouldn't have been denied as inclusive, there are two separate procedures for this patient.
Please review this claim and adjust accordingly, Thank you.
Sincerely,
AngelBean
Claims Correspondent
This letter introduces a regulatory agency the New York State Medicaid Bureau of Certification and Surveillance.
7 April 2010
Brooklyn Kings Highway Anesthesia, LLP
P.O. Box 270
Islip, NY 11762-0270
HealthFirst Medicaid
Attn: Appeals
P.O. Box 5170
New York, NY 10274
To Whom It May Concern,
Please resubmit this claim for review. We received $687.50 from you as payment on this claim. In accordance with our contract with you we should have been paid $797.50.
We were paid correctly on all procedure codes except for 36489, which is denying as inclusive. Per Medicaid guidelines this procedure code is payable and not inclusive to the main procedure. If you do not follow Medicaid guidelines please kindly let us know in writing.
We have appealed this claim on several different occasions and received no response from you. If we do not get a response from you within 60 days you leave us no choice but to report you to the New York State Medicaid Bureau of Certification and Surveillance.
If I can be of any further assistance in this matter please feel free to contact me at 631-123-4567 ext 891. Thank you and have a great day.
AngelBean
Claims Correspondendent
Please note for this claims letter you would send along a paper HICFA 1500 form as well.
Keywords
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Contributor's Note
Written by Angelique author of 91 Smart Sounding Phrases To Put In Your College Academic Papers and Other College Survival Tips https://www.createspace.com/3348044 DOWNLOAD College Academic Paper Writing Help and Other College Survival Tips http://linkbee.com/CollegeBook CEO of BusinessBuzzSEO Search Engine Optimization Services For Your Website http://businessbuzzseo.tripod.com/index.html AngelBean on Associated Content http://www.associatedcontent.com/user/241469/angelbean.html
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