Sample letter appealing health plan denial
Psoriasis patients have the right to appeal a denied claim from their insurance company. The National Psoriasis Foundation provides information to patients and physicians to help them navigate the appeal process.
Information on how to appeal is often included in the denial letter from the insurer. If the information is not included in the denial letter, the patient can write to the insurer and request the information (see template below). It is best to appeal any denial by an insurer as soon as possible. Many insurance companies place limits on how long appeals may be filed following the denial of a claim.
You may copy or print this letter to use as a model. Note: This letter is only an example. Please edit the letter to suit your needs. This page can also be downloaded as a PDF document.
[Today’s date]
[Name of medical director]
[Name of insurance company]
[Street address]
[City] [State] [ZIP code]
Dear [Name of medical director],
[Name of health plan] has denied my claim for [name of therapy/drug] for my psoriasis [and/or] psoriatic arthritis. 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
My physician, [name of prescribing physician], and I disagree with [name of health plan]'s ruling on my case. Please send me information detailing how I can appeal your denial of my therapy, which was prescribed by my physician and is medically necessary.
Sincerely,
[Your name]
[Address]
[Phone number]
| CC: | [Name of prescribing physician]
[Name of your insurance plan administrator at your work]
National Psoriasis Foundation |
1 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.
2 Gelfand JM, Troxel AB, Lewis JD, Kurd SK, Shin DB, Wang X, Margolis DJ, Strom BL. The risk of mortality in patients with psoriasis. Archives of Dermatology. 2007;143(12):1493-1499.
3 Young M. The psychological and social burdens of psoriasis. Dermatology Nursing. 2005;17(1):15-9.
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