Appeal Letters

What do you do when your health insurance plan denies your prior authorization request? Appealing to your insurance provider often feels intimidating for many people. Partnering with a reliable service provider can make the appeal letters process less taxing.

Documented Appeal Letters

Sustain Meds is your best bet for properly documented appeal letters with the best approval chance. Important to this process is knowing the exact reasons the prior authorization was denied. Our expert team addresses the denial reasons while citing your policy’s terms.

Do you need help responding to a denial letter from your insurance provider? Reach out to Sustain Meds today, and we’ll do the heavy-lifting for you. Our reliable team crafts well-documented letters that can make a good case for you. Our services ensure that you keep enjoying your prescribed care plan.

At Sustain Meds, we work round the clock to ensure that your prescription treatment plan comes to fruition. We give you the best chance of successfully getting your plan through the administrative process.

appeal letter

When Do You Need Health Insurance Appeal Letters?

appeal letter

Experimental Treatments

Most insurance providers do not provide coverage for experimental treatments. Before receiving your coverage, you’ll need to prove that the treatment meets these conditions:

  • The medical community considers it a standard treatment
  • It is less expensive
  • Your plan has covered patients with similar conditions previously

Not-Medically Necessary Treatments

Insurance providers might deny your claim if the recommended treatment was not medically necessary. Ideally, you’d need written proof from your doctor or healthcare provider regarding why you need the treatment in question.

Health Care Setting

You’ll have to go the extra mile to prove that you need coverage for in-home care. First, your provider might require you to avail an in-home care plan they have approved. Also, you will need to show that your healthcare provider deems that in-home care will work better for you. In other instances, insurance providers will only pay for in-home care less expensive than hospitalization.

How Do We Use Appeal Letters for a Denied Prior Authorization?

Before starting the appeal process, our team takes time to understand the denial letter. We’ll assess why your insurance provider denied coverage along with the appeal process and timelines. Our team will also work with you to understand your insurance coverage and gather relevant medical records.

From the denial letter, we’ll find out the deadline for your appeal and where we’ll need to send it. Once we determine the available appeal options, our team will start drafting a concise letter for your appeal.

What Do We Include in Appeal Letters?

At Sustain Meds, we specialize in creating appeal letters that indicate why your plan should cover the claim. Our team will go into great detail about why you need the prescribed medical service. We’ll also affirm why your insurance policy covers the service, citing necessary policies. Surprisingly, many prior authorizations need to go to appeal because a provider’s office did not include the proper documentation. The appeal letter is a chance to get this sorted out.

The appeal letter will also include details from your medical provider. Our team will reach out to your provider and ask them to prepare a medical necessity letter. Besides, we’ll ensure that we cover prior treatments and the necessity of the current treatment. We use evidence-based information to give your claim the attention it deserves.

The elements of a successful appeal letter include:

  • Patient credentials, policyholder name, and policy number
  • Accurate patient contact information
  • Contents of the denial letter, including the denial reason
  • Medical provider’s details
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    What Comes Next after Submitting an Appeal?

    Sustain Meds keeps tabs on the appeal letter, ensuring the appeal gets to fruition. We’ll keep the confirmation of successful transmission to track the submission. 

    Our team will keep a record of the appeal letter and all the submitted materials. Count on us to record all your correspondence before and after submitting your appeal. Our stellar organization ensures that your insurance provider doesn’t dismiss your claim before assessing it.

    Partner with Us for Consistent Prescription Cost Savings

    Having trouble taking charge of your prescription costs? Sustain Med’s case representatives are only a phone call away. Let us give you peace of mind with the knowledge that your prescriptions don’t cost more than they should.

    Whether you are uninsured, commercially insured, or have medicare plans, we have you covered. Reach out to us today for the best prescription cost solutions.

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    Sustain Meds is a leading Authorized Representative that acts on the patients behalf to ensure their prescription treatment plan issued by the doctor has the best chance of getting through the administrative process.