Accessing Health Care

Resources: Sample letters

Sample letter appealing to the state insurance commission

Specific instructions for applying to your state's insurance review program are at the Kaiser Family Foundation.

[Today's date]

[Name of State Insurance Commission]
[Name of Insurance Company]
[Street Address]
[City] [State] [ZIP code]

Dear Insurance Commissioner,

I filed the attached insurance claim with [health plan name] on [date of claim]. My physician has deemed [name of treatment] medically necessary for my psoriasis [and/or] psoriatic arthritis; however, in spite of this my insurance company has denied me access to this therapy.

Psoriasis—and the psoriatic arthritis that accompanies it in approximately 30 percent of cases—is a chronic, autoimmune disease that appears on the skin and/or in the joints. There is no cure for psoriasis and psoriatic arthritis.

Psoriasis and psoriatic arthritis can have a significant negative impact on a patient's health. Researchers have found that psoriasis causes as much disability as other major diseases, such as cancer, arthritis, hypertension, heart disease, diabetes and depression.1 People with severe psoriasis are likely to have a shorter life expectancy than those without the disease, according to recent studies.2

Without proper treatment, psoriasis and psoriatic arthritis can be physically and emotionally devastating for the patient, hindering his or her daily activities, affecting productivity at work and reducing quality of life.3

I have had the following specific problem(s) with this insurance company:

  1. Example: [name of health plan] has refused to cover my physician prescribed, medically necessary therapy.
  2. Example: My claim has been neither paid nor denied.
  3. Example: [name of health plan] has not acknowledged my request for a copy of their policy regarding the therapy my physician has prescribed me.
  4. Example: In violation of my policy, [name of health plan] has denied my claim.

Please accept this letter as a formal written request for review by the [State insurance commission] of my claim with [health plan].

Sincerely,

[Your name]
[Mailing address]
[Phone number]

CC: [HR Director at your workplace]
      [Name of your physician]
      National Psoriasis Foundation

1 Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardial infarction in patients with psoriasis. Journal of the American Medical Association. 2006;292(14):1735-1741.
2 Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB, Gelfand JM. Prevalence of cardiovascular risk factors in patients with psoriasis. Journal of the American Academy of Dermatology. 2006;55(5):829-35. Epub 2006 Sep 25.
3 Rapp SR, Feldman SR, Exum ML, Fleischer AB Jr, Reboussin DM. Psoriasis causes as much disability as other major medical diseases. Journal of the American Academy of Dermatology. 1999;41(3 Pt 1):401-7.