Your appeal letter should be concise and complete. It should also include only the facts about your case. Try to refrain from expressing feelings and opinions in general or about your healthcare plan. As you begin to put your appeal in writing, the following items should be included in your letter:

• A brief explanation of your health problem and treatment history.
• A brief explanation of how you have exhausted all other reasonable alternatives.
• Your physician’s recommendations for the procedure.
• A brief explanation of why you are an ideal candidate for the procedure.
• A brief explanation of what will happen or what alternatives you will have if the procedure is not approved.
• Support letters from other treating or referring providers.
• Quotes from your benefit plan that contain helpful language pertaining to your case.
• Medical records and clinical/diagnostic studies that support your position.

• Supporting documentation may include peer-reviewed articles, procedure overview, and other relevant literature.

To review appeal letters that include these key elements, you may wish to download sample letters of appeal.

Once you have sent your appeal, it may help to keep an eye on its progress. Be sure to pay attention to the following items:

• Track relevant dates to ensure that your appeal is moving forward without delay
• Be prepared to spend time on the phone
• Keep a record of all communications, including the date and time of your conversation, the full name and title of the person with whom you spoke, and a summary of items discussed. You will need this information if an external appeal with the state becomes necessary.

As you make your way through the appeal process, it may also help to understand what to expect when attending appeal hearings.