Medical Billing Error

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

{Date}

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}. On {date}, {insurance plan} denied coverage of the claim, stating that the {diagnosis/prescription/procedure} was not medically necessary.

The initial claim filed by {Provider} contained a billing error that mislabeled {diagnosis/prescription/procedure code} as {incorrect code}. Attached is the corrected claim. I think you will agree that {correct diagnosis/prescription procedure} was medically necessary and completely justified.

I hope that this helps clear things up. Thank you for your time and consideration.

Sincerely,

{Sender Name}

Index of Hardship Letter Examples