Sample Appeal Letter - WRS Wiki

PRACTICE NAME

20 MAXWELL AVENUE EVANSVILLE, IN 47711-4359

PHONE# (812) 422-7974

July 29, 2020

Trustmark

PO BOX 2905

Clinton, IA 52733

Patient Name: SMITH, JOHN

Member ID#: WB000XXXX;

Group #: WB00XX

DOB: 08/18/XXXX

Claim#: 071520-117-00

Date of Service: 06/11/2020

Charge Amount: $212.00

To Whom It May Concern,

Please accept this letter as a formal appeal for the denied claim mentioned above. It has been denied as Telemedicine services not covered since part of the plan exclusion.

As you know, the patient has been under the provider care for treatment since April of 2018. Due to the pandemic Covid-19, people are encouraged to stay at home. Health care had to be done via an internet platform for the patient to receive continuous treatment.

We would like to request you to reconsider the determination as this is not an option and it is a MUST. We and our patients cannot risk as they might be exposed to the virus. As you know Covid19 had killed thousands of people. Our only goal is to ensure the wellbeing of our patients despite the crisis we are facing.

Your attention to this matter is highly appreciated. Please let us know for any update or needed information. You can call us at 1-866-977-4367 ext 79317 or email us at billing@waitingroomsolutions.com. Thank you.

Sincerely,

Billing Services