i just strated school and one of the assignments is to file an appeal for a doctor stating that he wants more money then the insurance company paid him and i have no idea on how to even start this letter can some one help me please?
http://owl.english.purdue.edu/owl/resource/681/01/
Scroll down past the cover letter and resume sections. Under More Professional Writing Resources, you will find different links that will help you write and format a business letter.
The primary reason I'd use for this purpose is the doctor's costs. If he bills the insurance $100 for a standard office visit, but the insurance decides that $55 is the "reasonable" cost, you will need to show the costs he has (salaries, building lease/rent, utilities, etc.) that necessitate the $100/visit charge ... or whatever amounts you decide to include.
thank you
You're welcome.
i just don't know how to start the letter
You need to be as factual as possible ... no emotion. Just state facts.
Read through several of the model letters included in that website. Notice the tone of the letters. It's calm and professional, not emotional or whiny or demanding.
Start out with the facts of what happened -- your office billed the insurance company $xxx for Mr. S----'s office visit on June 8, 2010, which included an extended examination and referral for lab work and radiology, etc., etc.
Use your imagination and any information you can find in your text or study materials. Surely you aren't supposed to make this up out of thin air!
I have to do a research paper on medical billing and coding and I need a thesis and the body of the paper can someone help me..
Of course! I can help you learn how to write an appeal letter for a doctor who wants more money from an insurance company. Writing an effective appeal letter involves several key steps. Let's break it down:
1. Understand the Situation: Start by thoroughly understanding the doctor's case. Review any relevant documents or communication from the insurance company that explain why they paid the doctor less than requested.
2. Research: Familiarize yourself with the insurance company's policies and guidelines for reimbursements. This will help you address their concerns and argue your case effectively.
3. Format and Tone: Begin the letter with a professional salutation, such as "Dear Claims Department" or "To Whom It May Concern." Maintain a respectful and polite tone throughout the letter, focusing on the facts and avoiding emotional language.
4. Introduction: In the opening paragraph, clearly state the purpose of your letter – to appeal the insurance company's decision regarding the doctor's payment. Provide necessary details, like the doctor's name, the insurance claim number, and the date of the original claim.
5. Background Information: Provide a brief overview of the services rendered, the diagnosis, and the treatment provided by the doctor. Include any supporting medical records or documentation to strengthen your case.
6. Explanation and Arguments: In the subsequent paragraphs, explain the reasons why the insurance company's payment was insufficient or incorrect. Use specific examples and reference relevant policies. Present any additional supporting evidence, such as medical codes, guidelines, or expert opinions.
7. Address Counterarguments: Anticipate the counterarguments that the insurance company may raise, and address them in a logical and persuasive manner. Align your arguments with the insurance company's guidelines and demonstrate how the doctor's services meet their criteria.
8. Request for Reconsideration: Politely request that the insurance company reevaluates the doctor's claim and provides a reconsideration with a fair payment. Clearly state the desired outcome, such as an increased payment or a revised explanation of benefits.
9. Closing: Conclude the letter by expressing gratitude for the insurance company's attention and your willingness to provide any additional information or clarification as needed. Finish with a professional closing, such as "Sincerely" or "Best regards," and include your contact information.
10. Proofread and Send: Before sending the letter, carefully review it for errors or typos. Ensure that all necessary supporting documentation is attached. You may send the letter via email or mail, depending on the insurance company's preferred method of communication.
Remember, it's important to customize the letter to your specific situation and include any relevant details or documentation. Consulting with the doctor or seeking guidance from a supervisor or mentor experienced in healthcare appeals can also be valuable.