Medical Prescription Denial

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

{Date}

Dear {Insurance Representative}:

I am writing to request reconsideration for a claim denial that was filed by {Provider} on {date} for {Patient}. The claim number is {number} and the total amount was {amount}. On {date}, {insurance plan} denied coverage of my prescription for {drug name} on the basis that it was not medically necessary. I would like to contest this assessment and ask for reconsideration of my claim.

Enclosed is a letter from my doctor outlining why my prescription is medically justified. {Brief description of what drug name does for your condition}. There are no alternatives that provide the same effect, and without the medication, {result}. I have also enclosed two articles from the accredited medical journals, {Journal One} and {Journal Two}, that testify to the necessary effects of this particular drug for my condition.

Thank you for your reconsideration in this matter. I will contact you next week to discuss this claim further.

Thank you,

{Sender Name}

Index of Hardship Letter Examples