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You may be eligible for a government subsidy if your household income is under:
The Affordable Care Act (ACA) offers subsidies based on your household income, family size, and Qualifying Life Events.

You may qualify if...
One of the life events below has happened to you in the past 60 days:
  • I got married or divorced
  • I had a baby
  • A member of my family died
  • I moved to another state
  • i lost my job
  • I started a new job
  • I lost my health insurance coverage
and
Your income is under:
  • $45,960 - Individuals
  • $62,040 - Family of 2
  • $78,120 - Family of 3
  • $94,200 - Family of 4

Second-level letter of appeal for a health insurance claim denial

[Your name]

[Your address]
[Your city, state, ZIP]
[Your phone number]

[Date]

 

Attn: Director of Claims
[Name of insurance company]
[Insurance company address]
[City, state, ZIP]

    Re:     Patient: [patient name]
    • Policy: [insurance policy number]Insured: [name of insured person]Treatment dates: [admission date] - [discharge date]Amount: [total charges]

Dear [Mr./Ms./Director of Claims name, if available],

 

On [date of first letter], I appealed a denied claim for [name of insured person]. A copy of that claim and appeal letter is enclosed.

 

I have not heard from you [or the claim remains denied; or give other reason here]. I am requesting a hearing to resolve this matter. I feel that denial and nonpayment of this claim has jeopardized [my/name of insured person('s)] access to health care [or give other reason here].

 

If I do not hear from you within 10 days, I am referring this matter to the consumer assistance division of the [state name] Attorney General's Office, [state name] Department of Insurance, and may also seek private legal counsel.

 

In my opinion, you have failed in your obligation to provide acceptable and adequate service. Be assured that I intend to use every available means to get this matter resolved.

 

Sincerely,

 

[your signature here]

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Find Affordable Health Insurance Now!

Please enter valid Zip Code.
Please enter valid date.
You may be eligible for a government subsidy if your household income is under:
The Affordable Care Act (ACA) offers subsidies based on your household income, family size, and Qualifying Life Events.

You may qualify if...
One of the life events below has happened to you in the past 60 days:
  • I got married or divorced
  • I had a baby
  • A member of my family died
  • I moved to another state
  • i lost my job
  • I started a new job
  • I lost my health insurance coverage
and
Your income is under:
  • $45,960 - Individuals
  • $62,040 - Family of 2
  • $78,120 - Family of 3
  • $94,200 - Family of 4
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