March 18, 2018
Wrong Plan

This wrong plan appeal letter template can be tailored to fit your denial. For assistance with a completely researched, focused and custom letter, call the helpline @ 920.664.9407.
Your name and address 
Address of Claims review department 
RE: Name of Insured:
Plan ID #:
Claim #: 
Dear Claims Review Department:
I am writing to you in regards to a claim submitted by [Medical Provider] for [patient].  The charges were rendered on [Date] and totaled [Claim dollar total].  [Health Plan] has denied payment on these charges.
I provided a copy of my insurance card and completed the Registration Form indicating the name and type of insurance I hold at the time I received medical treatment. Unfortunately, my medical provider (name the physician or hospital facility) billed the wrong health plan.  
Due to this error, my health plan (name the health plan), is denying my claim because it was not submitted in a timely manner.  However, please consider that I did provide my correct insurance information at the time of service and though it did not reach the proper health plan, it was billed on time. 
I feel I should not be penalized for this administrative mistake.  Please reconsider this claim and pay the appropriate benefits to the medical provider  If you require additional information or have questions, please contact my medical provider directly at [phone number].
Thank you for your time and consideration.
[Insured’s Name]
By request, additional information from the medical provider
Billing information of the claim sent originally, including billed date

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