How To Start A Letter Of Appeal – Being judged can have long-term negative consequences for your career. Many people mistakenly believe that they have no choice but to flee when an unfair decision has been made against them, but they do.
In this article we will learn what an appeal letter is, how to write one and provide some examples of appeal letters.
How To Start A Letter Of Appeal
A letter of appeal is a written action someone takes when they believe the situation needs to be reviewed. Decisions are subject to change until they are finalized on paper. There are various situations that may warrant participation, including:
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Sending a well-crafted grievance letter or email is one strategy for achieving a desired outcome when you have been wronged in a business situation.
You already feel frustrated when a business decision doesn’t go in your favor, but standing up for yourself through an appeal has the potential to turn things around.
The appeal letter is a professional and formal document that requests action and therefore should be written in a business letter format. The format of how the letter will be addressed differs slightly between mail and email.
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Skye Ariella is a professional freelance writer, originally from New York. She has been featured on websites and online magazines covering career, travel and lifestyle topics. She earned her BA in Psychology from Hunter College. First of all, the obvious. It is a psychological term often used to describe a natural defense mechanism that we ignore when we feel uncomfortable.
Second, it is a term best described as a medical organization’s worst nightmare. You see, another concept of denial in health care is when an insurance company does not accept services provided by a doctor.
Sure, you could say I’m a little melodramatic. After all, experienced billing professionals will be the first to tell you that denials are less avoidable and more inevitable. He has a point.
How To Write An Effective Appeal Letter
There are thousands of different reasons for denial, and there are just as many, if not more, techniques to implement in your organization to prevent them. However, this piece is beyond the scope of this particular blog post.
Since many professionals see them as an essential part of the medical billing landscape, what can you do when your office receives one?
After all, if you’ve provided care to a patient… your organization deserves to be paid. However, the medical claim denial scenario is grim for modern healthcare facilities. A recent study found that denial deletion averages 53%.
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A high percentage is not something many organizations can afford, leaving smaller practices with a difficult decision to make.
Not only are you already at a statistical disadvantage when it comes to medical claim denials, you are also at a time disadvantage.
You see, most doctors already say they need at least 50% more time with patients. No wonder burnout is blighting the healthcare landscape.
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In other words, this statistic proves that traits have no time. And, if these organizations had more time, they would allocate it to their customers. I don’t blame them…that’s why these places exist.
Anyway, the point I’m trying to make with all of this is that while having the insurance provider pay for a claim helps keep the lights on, it doesn’t trump the customer’s time.
All of this chaos leads us to the previous number, which shows the average claim denial rate.
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So, if time is a factor in why your agency is not sending the medical claim denial objection letter, what should you do?
This first appeal letter sample from Mount Home Arts is exactly the same template. Whenever you receive a medical claim denial, there are facts you will always get back, such as…
Now, that’s not a lot of data, but you’ll need it because you already have all the extra information at your disposal.
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Link what comes from the insurance agency and the information you already know in the complaint letter template. Before you know it, you’ll have all your objections ready to resubmit in half the time it took you to set up the template.
For healthcare providers, branding is often an afterthought. I’m not trying to single you out if you fall into that majority, that’s what I said earlier. Your number one priority is taking care of your customers.
Not to mention the fact that often a doctor’s name and title carry enough weight in most eyes to know that anything they send is important.
Sample Appeal Letters For Medical Claim Denials That Actually Work — Etactics
In other words, while being a doctor is a great achievement that commands a certain level of respect, it doesn’t make your appeal letter any more likely to be successful.
All of this means you need to find a way to make your letter stand out.
The best way to achieve this is to incorporate your brand throughout the document. This example from Arthritis.org accomplishes this technique very well.
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You see, a professionally designed appeal letter that incorporates your organization’s logo and colors changes the entire dynamic of what you’re sending.
This record should include not only a copy of what you sent, but also when you sent it and when it arrived at the insurer. The last part of the last sentence is the most important.
Whether you send your objection letter by mail or online, it is imperative that you have tracking information.
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This is such an important piece of the puzzle because it gives you a look at the timeline of the process involved in trying to get a denied claim reconsidered.
There is also a harsh reality that communicates with insurance carriers. In an ideal world, once an insurance provider receives an appeal letter, they respond to it and correct any mistakes that may have been made.
Unfortunately, this is not the reality. You may need to have multiple contacts with providers regarding disclaimers for medical claims. But if you don’t keep records and/or don’t know how to track what you send, it makes the tracking process more difficult.
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Since insurance providers are the organizations that reject your medical claims, they have no choice but to follow a standardized process.
The form above is only the first page of the appeal form provided by Medical Mutual.
Maybe this is the golden sample. We can throw out every other sample I saw earlier in this blog post, right? Wrong.
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You see, it is possible to fill out an online appeal letter form on the websites of small scale insurance carriers.
However, not every patient seeking help at your doorstep uses Medical Mutual. I bet if ten of your patients walked through your door at the same time, less than half of them would use the same insurance.
In other words, you and your staff can’t keep track of all the different electronic appeal forms for every denial you receive… from all the different insurance carriers your patients use.
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Okay, at this point you’ve seen several different sample objection letters that you can use as a basis for creating your own.
Viewing the samples provided so far will help you reduce the time it takes to resubmit your medical claim disclaimer, no doubt.
But what if I told you that there is a sample objection letter format that can save you even more time?
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Okay, I know what you’re thinking. The sample above is essentially the same as in the previous section. You are correct, except for the fact that it is UnitedHealthcare instead of Medical Mutual.
That way, you won’t have to worry about having a template, keeping records of tracking information, and manually entering information into insurance agency forms. Although such a solution costs money, it reduces its cost over time and makes you money in the long run.
By the end of this blog post, you’ve been through a whirlwind of emotions. While the various medical claim denial appeal letter samples are worth considering, they are not the best choice.
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To really tackle the mountain of denial facing your organization, you have two options.
First, you can be like most healthcare practices and write off your denials as a loss on your books every year. Second, you can invest a little money in a solution that streamlines the entire objection letter process.
The second option helps you overcome the denial situation, thereby increasing your organization’s overall revenue.
How To Write A Medical Claim Appeal Letter (with Pictures)
*The information and topics discussed in this blog are intended to promote participation in care. It is not intended to replace your doctor’s treatment plan or orders. Any concerns about your specific treatment options should be discussed with your primary care physician or other licensed practitioner.
**The information contained in this blog is not intended to be legal advice and cannot be used as legal advice. Efforts are made to ensure all information provided
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