Sample Letters To Use With Insurance Companies-Books Pdf

Sample letters to use with insurance companies
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Sample Letter 1, Request that the copay for the psychiatrist from the patient be changed to a. medical copay rate instead of the higher mental health copay because the. psychiatrist was providing medication management not psychotherapy. Adjustments can be made so that the family is billed for the medical copay Remember the psychiatrist must use the. proper billing code, To Name of Clinical Appeals Staff Person. INS CO NAME ADDRESS, From YOUR NAME ADDRESS, Re PATIENT S NAME. DOB Date of Birth, Insurance ID, Dear obtain and insert the name of a person to address your letter to avoid sending to a generic title or To Whom It. May Concern, Thank you for assisting me with my son s daughter s medical care As you can imagine this process is very emotionally.
draining on the entire family However the cooperation of the fine staff at INSURANCE COMPANY NAME makes it a little. At this time I would like to request that INS CO review the category that Dr NAME s services have been placed into It. appears that I am being charged a copay for his her treatment as a mental health service when in reality he she. provides PATIENT NAME with pharmacologic management for his her neuro bio chemical disorder Obviously this is. purely a medical consultation Please review this issue and kindly make adjustments to past and future consultations. Thank you in advance for your cooperation and assistance. Cc list the people in the company you are sending copies to. 2012 National Eating Disorders Association Permission is granted to copy and reprint materials for. educational purposes only National Eating Disorders Association must be cited and web address listed. www NationalEatingDisorders org Information and Referral Helpline 800 931 2237. Sample Letter 2, The need to flex hospital days for counseling sessions Remember just because. you are using outpatient services does not mean that you cannot take advantage. of benefits for a more acute level of care if your child is eligible for that level of. care The insurance company only knows the information you supply so be. specific and provide support from the treatment team. 10 Hospital days were converted to 40 counseling sessions. To Name of an individual in the Ins Co Management Dept. INS CO NAME ADDRESS, From YOUR NAME ADDRESS, Re PATIENT S NAME. DOB Date of Birth, Insurance ID, Dear insert name, This letter is in response to insurance company name s denial of continued counseling sessions for my daughter son I. would like this decision to be reconsidered because insert PATIENT NAME continues to meet the American Psychiatric. Association s clinical practice guidelines criteria for Residential treatment Partial hospitalization His Her primary care. provider NAME supports his her need for this level of care see attached Sample Letter 3 below provides an. example of a physician letter Therefore although he she chooses to receive services from an outpatient team he she. requires an intensive level of support from that team including ongoing counseling to minimally meet his her needs I. request that you correct the records re PATIENT NAME s level of care to reflect his her needs and support these needs. with continued counseling services since partial hospitalization residential treatment is a benefit he she is eligible for. and requires, I am enclosing a copy of the APA guidelines and have noted PATIENT NAME S current status If you have further questions. you may contact me at PHONE or Dr NAME at PHONE, Thank you in advance for your cooperation and prompt attention to this matter.
Cc Case manager, Ins Co Medical manager, 2012 National Eating Disorders Association Permission is granted to copy and reprint materials for. educational purposes only National Eating Disorders Association must be cited and web address listed. www NationalEatingDisorders org Information and Referral Helpline 800 931 2237. Sample Letter 3, Letter to a managed care plan to seek reimbursement for services that the. patient received when time was insufficient to obtain pre authorization because. of the serious nature of the illness and the need to deal with it urgently. Remember you need to research the professionals available through your plan. and local support systems In this case after contacting their local association for. eating disorders experts the family that created this letter realized that no qualified medical experts were in their area to. diagnose and make recommendations for their child Keep in mind that you need to seek a qualified expert and not a. world famous expert Make sure you provide very specific information from your research. Reimbursement was provided for the evaluating treating psychiatrist visits and medications Further research and. documentation was required to seek reimbursement for the treatment facility portion. To Get the name of a person to direct a letter to, INS CO NAME ADDRESS. From YOUR NAME ADDRESS, Re PATIENT S NAME, DOB Date of Birth. Insurance ID, Dear insert name, My son daughter has been under treatment for name the eating disorder and any applicable co existing condition since.
month year He she was first seen at the college health clinic at UNIVERSITY NAME and then referred for counseling. that was arranged through INS CO At the end of the semester I met with my son daughter and his her therapist to. make plans for treatment over the summer At that time residential treatment was advised which became a serious. concern for us We then sought the opinion of a qualified expert about this advice I first spoke to PATIENT NAME S. primary physician and then contacted the local eating disorders support group No qualified expert emerged quickly from. the community of our INS CO network providers In my research to identify someone experienced in eating disorder. evaluation and treatment I discovered that insert Dr NAME at HOSPITAL in LOCATION was the appropriate person to. contact to expedite plans for our child Dr NAME was willing to see him her immediately so we made those. arrangements, As you can imagine this was all very stressful for the entire family Since continuity of care was imperative we went ahead. with the process and lost sight of the preapproval needed from INS CO I am enclosing the bills we paid for those initial. visits for reimbursement PATIENT NAME was consequently placed in a residential setting in the LOCATION area and. continues to see Dr NAME through arrangements made by INS CO. Also at the beginning of his her placement some confusion existed about medications necessary for PATIENT NAME. during this difficult acute care period At one point payment for one of his her medications was denied even though the. treatment team recommended it and it was prescribed by his her primary care physician Dr NAME I spoke to a INS. CO employee insert name at PHONE to rectify the situation however I felt it was a little too late to meet my. timeframe for visiting PATIENT NAME so I paid for the Rx myself and want reimbursement at this time If you have any. questions please speak to employee name, Thank you in advance for your cooperation I d be happy to answer any further questions and can be reached at PHONE. 2012 National Eating Disorders Association Permission is granted to copy and reprint materials for. educational purposes only National Eating Disorders Association must be cited and web address listed. www NationalEatingDisorders org Information and Referral Helpline 800 931 2237. Sample Letters 4, To continue insurance while attending college less than full time so that student. can remain at home for a semester due the eating disorder Note When a student. does not register on time at the primary university at which he she has been. enrolled insurance is automatically terminated at that time Automatic termination can cause an enormous amount of. paperwork if not rectified IMMMEDIATELY The first letter informs the insurance company of the student s current. enrollment status in a timely fashion and the second letter responds to the abrupt and retroactive termination Students. affected by an eating disorder may be eligible for a medical leave of absence from college for up to one year so you may. want to inquire about that at the student s college. The student was immediately reinstated as a less than full time student. To NAME OF CONTACT PERSON, INS CO NAME ADDRESS, From YOUR NAME ADDRESS. Re PATIENT S NAME, DOB Date of Birth, Insurance ID.
We spoke the other day regarding my son s daughter s enrollment status I am currently following up on your instructions. and appreciate your assistance in explaining what to do Dr NAME is sending you a letter that should arrive very soon. about PATIENT NAME s medical status that required him her to reduce the number of classes he she will be able to. take this fall When he she completes re enrollment at UNIVERSITY NAME which is not possible to do until the first day. of classes DATE he she will have the registrar s office notify you of her status. At this time NAME plans to be a part time student at UNIVERSITY for the DATE semester and plans to return to. UNIVERSITY in DATE provided his her disorder stabilizes If all goes well he she may be able to graduate with. his her class and complete his her coursework by the DATE in spite of the medical issues Please feel free to get. answers to any questions regarding these plans from PATIENT NAME S academic advisor Mr Ms NAME whom PATIENT. NAME has given written permission in a signed release to speak to you This advisor has been assisting my son daughter. with his her academic plans and is aware of his her current medical status The advisor s phone number and email are. PHONE email, Please feel free to contact me at PHONE if you have any questions or need any further information Thank you for your. assistance, 2012 National Eating Disorders Association Permission is granted to copy and reprint materials for. educational purposes only National Eating Disorders Association must be cited and web address listed. www NationalEatingDisorders org Information and Referral Helpline 800 931 2237. Sample Letter 5, Follow up letter to enrollment department after coverage was terminated. retroactively to June 1st by the insurance company s computer. HEADING SAME AS PREVIOUS LETTER, I am sure you can imagine my shock at receiving the attached letter copy of the letter you received that my. son daughter received about termination of coverage NAME has been receiving coverage from INSURANCE. COMPANY for treatment of serious medical issues since DATE We have received wonderful assistance from NAME. Case Manager PHONE NAME Mental Health Clinical Director PHONE and Dr NAME INS CO Medical Director. PHONE I am writing to describe the timeline of events with copies to the people who have assisted us as noted above. In DATE PATIENT NAME requested a temporary leave of absence from UNIVERSITY 1 NAME to study at UNIVERSITY 2. NAME for one year He she was accepted at UNIVERSITY 2 NAME and attended the DATE semester At the end of the. spring semester PATIENT NAME S medical issues intensified and PATIENT NAME returned home for the summer The. summer of YEAR has been very complicated and a drain on our entire family The supportive people noted earlier in this. letter made our plight bearable but we were constantly dealing with one medical issue after another. At the beginning of August PATIENT NAME and the treatment team members began to discuss PATIENT NAME s needs. for the fall semester of YEAR As far as our family was concerned all options UNIV 1 UNIV 2 several local options full. and part time needed to be up for discussion to meet patient name s medical needs We hoped that with the help of. his her medical team we could make appropriate plans in a timely fashion. During PATIENT NAME s appointments the first two weeks of August the treatment team agreed that PATIENT NAME. should continue to live at home and attend a local university on a part time basis for the fall semester This decision was. VERY difficult for PATIENT NAME and our family PATIENT NAME still hopes plans to return to UNIV 1 in date as a. full time student He she has worked with his her UNIV 1 advisor since date to work out a plan that might still allow. him her to graduate with his her class even if he she needed to complete a class or two in the summer of YEAR This. decision by NAME was difficult but also a major breakthrough necessity for his her treatment. After a workable plan was made I called the enrollment department at INS CO NAME to gain information about the. process of notification regarding this change in academic status due to his her current medical needs INS EMPLOYEE. NAME communicated to me that I needed to have my child s primary care physician write a letter supporting these plans. This letter is forthcoming as we speak As soon as PATIENT NAME s fall classes are finalized on date that information. will also be sent to you, In summary PATIENT NAME intended to be a full time student this fall until his her treatment team suggested.
otherwise in the early August At that time I began notifying the insurance company Please assist us in expediting this. process I ask that you immediately reinstate him her as a policy member If his her status is not resolved immediately it. will generate a GREAT DEAL of unnecessary extra work for all parties involved and quite frankly I m not sure that our. family can tolerate the useless labor when our energy is so depleted and needed for the medical life issues at hand. Follow up letters with phone calls and document whom you speak to Don t assume one insurance department knows what the other is doing Don t panic Your current issue or rejection can be a computer generated glitch Copy letters to others relevant to the request Also if you are complimenting someone for the assistance they ve provided tell them you d love to send a copy to

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