Denied Claim Appeal Letter (Template & Guide)

[Your Full Name]
[Your Phone Number]
[Your Email Address]

March 25, 2026

[Insurance Company Name]
Appeals Department
[Insurance Company Mailing Address]

Re: Appeal of Claim Denial
Member ID: [Member ID]
Claim Number: [Claim Number]
Date of Service: [Date of Service]
Provider: [Provider Name]
Date of Denial: [Denial Date]

Dear Appeals Review Team,

I am writing to formally appeal the denial of the above-referenced claim, which was denied on [Denial Date]. According to the Explanation of Benefits (EOB), the stated reason for denial is: [Reason for denial as stated on your EOB]. I believe this denial is incorrect and respectfully request that the claim be reconsidered and reprocessed.

REASON FOR APPEAL

The denial reason cited is inaccurate for the following reason(s):

[Explain why the denial reason is incorrect. For example: "The claim was denied for an incorrect CPT code, but the correct code is 99213 as confirmed by my provider." Or: "The claim states I am out-of-network, but my provider is in-network under my plan as shown in the attached network directory listing."]

This appeal addresses one or more of the following common denial errors:

- Coding or billing errors (incorrect CPT, ICD-10, or HCPCS codes)
- Administrative mistakes (wrong member ID, missing information, data entry errors)
- Incorrect patient or subscriber information on the claim
- Out-of-network provider misclassification
- Timely filing disputes (claim was submitted within the required timeframe)
- Coordination of benefits issues between multiple insurers

SUPPORTING DOCUMENTATION

The following documents are enclosed to support this appeal:

☐ Copy of the denial letter / Explanation of Benefits (EOB)
☐ Corrected claim form or supporting records from provider
☐ Provider letter confirming the services rendered and correct billing information
☐ Any additional supporting documentation

REQUESTED ACTIONS

Based on the information and documentation provided, I respectfully request the following:

1. Reprocess the claim with the corrected information provided above
2. Apply benefits according to my policy terms and coverage
3. Issue payment to the provider or reimburse me for any out-of-pocket expenses incurred as a result of this denial
4. Provide written confirmation of the resolution of this appeal

APPEAL RIGHTS

I understand that I have the right to an internal appeal under my plan and, if this internal appeal is denied, the right to request an independent external review as provided by federal and state law. I expect this appeal to be reviewed and resolved within the timeframe required by my plan.

I respectfully request a written response within your plan's required timeframe for appeal decisions. Please contact me at [Your Phone Number] or [Your Email Address] if any additional information is needed.

Thank you for your prompt attention to this matter.

Sincerely,

[Signature]
[Your Printed Name]

Enclosures:
- Copy of denial letter / EOB
- Corrected claim form or supporting records
- Provider letter confirming services and correct billing
- Additional supporting documentation