Dear {Medical Provider},
I am writing to you as a last resort. Even though you advised me that my best option for treatment is {procedure}, my insurer is refusing to cover the procedure, arguing that it relates to a pre-existing condition. I've filed my {number} appeal on the matter, but in the meantime, I am {in pain/at risk}.
Might you see your way clear to write off some of your time and expenses for this procedure? I understand that there are fixed costs associated with the treatment I need, and I don't expect to get free medical care. I have managed to come up with {amount} by {draining savings/cashing out retirement/borrowing}. Might you accept this amount as payment?
My income has declined greatly due to {situation}, but I'm confident that once you're able to complete the treatment you suggested, I will be feeling much better and thus able to secure further funds.
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Index of Hardship Letter Examples