Sample Letters for Health Care Consumers Index
Please feel free to copy any of the following letters for your personal or nonprofit use -- not to be copied for commercial use. See information about copying our materials.
Billing Problems
A letter to use if you have been billed for all or part of a service that you believe should be covered by your health plan or medical group.Appeal of a Denial of Services as "Not Medically Necessary"
A letter to use if you believe you have been inappropriately denied a service, treatment or procedure based on your provider, medical group, or health plan claiming the service, treatment, or procedure is not medically necessary to treat, monitor or diagnose your condition.Appeal of a Denial of Services as “Not a Covered Benefit”
A letter to use if you believe you have been inappropriately denied a service, treatment or procedure because your provider, medical group, or health plan claims the service, treatment, or procedure is not a covered benefit under the terms of your health plan contract.Request for Coverage of a Non-formulary Prescription Drug
A letter to use if you are having trouble getting coverage for a prescription drug because the health plan or medical group says it is not on the “formulary,” or list of approved drugs.Quality of Care Complaint
A letter to use if you want to voice a complaint about the quality of care your have received.Request for Information
A letter to use if you want to request information from a provider, medical group or health plan (such as a copy of the contract, the formulary or list of approved drugs, or information about financial incentives that may affect your care).Cover Letter to State Regulatory Agency
A letter to use if you want to send a copy of a grievance or appeal letter to a state regulatory agency, requesting the assistance of the agency.Cover Letter to State Licensing Board
A letter to use if you want to make a complaint to a state licensing board, requesting that the board investigate a professionally licensed health care provider.
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This page last updated 9/25/99
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