Hardship Letter Insurance Denied

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

{Date}

To Whom It May Concern:

On {date}, I required {brief but specific description of medical transportation, operation, etc.} due to {medical emergency}. I was notified on {date} from {insurance company representative} that my request to have {percentage} of the cost covered by my insurance was denied because the {operation/transportation/etc.} was not medically necessary.

I request reconsideration in this case. Due to {hardship}, I was unable to seek out {medical alternative}. This {action} was my only option and therefore was completely medically necessary. If I had not sought out this action, I would have {medical consequence}.

In light of these circumstances, I respectfully ask for a reevaluation of my case. I have attached {a doctor's note, medical records, financial stubs, etc.} to substantiate my claim. Thank you for your consideration.

Thank you,

{Sender Name}

Index of Hardship Letter Examples