Date
Jane Doe
Case Manager
Insurance Company
City, State, Zip Code
Phone Number
Fax Number
RE: Anne B. Smith
Insurance Policy Number
DOB: 8/8/88
Dear Jane Doe:
This is a follow-up letter to summarize our phone conversation today at 3:15pm. If you have any dispute about what I say transpired, please notify me in writing (by mail or by fax) within two (2) business days of receipt of this letter. If I have not received a response by that time, then that will be tantamount to your acceptance of what I state in this letter.
In our conversation you stated that your insurance company was denying the coverage for our daughter Anne’s treatment at the West Coast Eating Disorder Treatment Center. Your stated reason for that denial was that her treatment was “not medically necessary.” I asked you to give me the name, title, and expertise regarding eating disorders of the medical director who has made the claim that this treatment is not medically necessary. You refused to give me that name in spite of my telling you that as a fully paid member I do have the right to now who in that company is making life-or-death decisions regarding my daughter. You stated also that this was “company policy.”
I, again, am asking to know what medical director made that decision and all contact information for that person, including address, direct phone number, and fax number. I am also requesting his or her qualifications to render a decision in this matter.
Your company’s delays have already cost my daughter much needed treatment time. These delays in treatment have resulted in further deterioration in her condition, ultimately extending her recovery and making it more difficult and more expensive. As time is of the essence and my daughter’s life is at risk, I can only allow a maximum of three (3) business days for a response.
I may be contacted at any time at the following numbers:
Sincerely,
Your Name
