Medical Appeal Letter Templates
Professional letter templates for insurance appeals, billing disputes, and financial assistance applications. These templates use proper legal language and include all necessary elements to improve your chances of approval. All templates are free to use and can be customized for your specific situation.
Why These Templates Are Effective
✓ Professional Legal Language
Written with terminology that insurance companies and providers respect
✓ Evidence-Based Requests
Demands specific documentation and criteria for stronger appeals
✓ Regulatory Compliance
References relevant laws and regulations that support your case
✓ Clear Next Steps
Includes escalation paths and follow-up procedures
Available Templates
Appeal "Not Medically Necessary" Denial
Challenge insurance denials claiming treatment was not medically necessary
60-180 days to appeal
Prior Authorization Appeal
Appeal denied prior authorization requests for treatments and procedures
30-60 days to appeal
Hospital Charity Care Application
Apply for financial assistance and charity care programs
Apply within 240-365 days
Medical Bill Dispute Letter
Dispute incorrect charges, billing errors, and overcharges
Dispute within 60-90 days
How to Use These Templates
Choose Your Template
Select the template that matches your situation: insurance denial, billing error, or financial assistance need.
Fill in Your Details
Customize the template with your specific information, case details, and supporting documentation.
Send & Follow Up
Submit your letter via certified mail and follow up according to the template's timeline guidance.
Best Practices for Medical Appeals
Before You Write:
- • Gather all relevant medical records, bills, and correspondence
- • Check your insurance policy or hospital's financial assistance policy
- • Note all deadlines - most appeals have strict time limits
- • Get a copy of the denial letter or billing statement in question
When Writing Your Letter:
- • Be specific about what you're appealing and what you want
- • Include all relevant dates, claim numbers, and reference numbers
- • Attach copies (not originals) of supporting documents
- • Keep the tone professional but firm
After Sending:
- • Send via certified mail with return receipt requested
- • Keep copies of everything you send
- • Follow up if you don't hear back within the stated timeframe
- • Document all phone calls and correspondence
Need More Help?
Need a Different Template?
We're continuously adding more letter templates for different situations. In the meantime, these resources can help with most medical billing and insurance issues:
Disclaimer: These templates are for educational purposes only and do not constitute legal advice. While these templates follow best practices, every situation is different. For complex cases or significant amounts, consider consulting with a qualified attorney or patient advocate. CareRoute is not responsible for outcomes from using these templates.