Hardship Letter Examples

   Lack of Medical Necessity

{Your Name}
{Your Address}
{Your Phone #}


Dear {Insurance Representative}:

I am writing with regards to a claim filed by {Provider} on {date} for {Patient}. The claim number is {number} and the total amount billed was {amount}. According to the rejection letter I received, my claim is being denied based on a lack of medical necessity.

I am requesting further information concerning the evaluation procedure for this health plan. I would like to contest this decision, and I kindly request that you reconsider. While your rejection states {rejection reason}, my physician agrees with me that the {procedure/prescription} is a medical necessity for my condition.

{Brief description of condition and why the procedure/prescription was necessary, and what would happen if you didn't have it.}

I appreciate your consideration in this matter. Enclosed is a statement from my physician.


{Sender Name}

Download this hardship letter — free!

Formatted and ready to use with Microsoft Word, Google Docs, or any other word processor that can open the .DOC file format.

Index of Hardship Letter Examples