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See a sample appeal letter
[Your Insurance Company]
Appeals Department
Re: Appeal of Denial — Member ID [XXXX] — Claim #[XXXX]
Dear Appeals Reviewer,
I am writing to formally appeal the denial of [treatment] issued on [date]. The denial cites lack of medical necessity; however, the attached clinical documentation and the following evidence demonstrate that this treatment is medically necessary and meets your plan's coverage criteria.
Medical Necessity: My diagnosis of [ICD-10 code] meets the criteria established in [clinical guideline citation]. Per [CMS NCD/LCD reference], this treatment is indicated when...
Full letter typically runs 2–3 pages with ICD-10 codes, CPT codes, legal citations, and plan-specific policy references — generated automatically from your denial.
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