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Thread: Appeal Letter

  1. #1

    Default Appeal Letter

    AAPC: Back to School
    Does anyone have a great insurance appeal letter they use for bi-lateral breast reconstruction when insurance companies decide not to pay accordingly to guidelines?

    If so please e-mail me to margaret@synergyplasticsurgery.com

    Thank you so very much!

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Short, Sweet, Specific

    Dear Insurance

    RE: patient, DOB, subscriber #, Group #, Claim #

    We are appealing level of payment for DOS / CPT / Description

    This procedure was performed bilaterally, and we appended the appropriate modifier(s).

    I enclose a copy of the operative report for your convenience. Please reconsider level of payment.


    Name, CPC

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default One more thing

    Oh, I also clearly underline the appropriate areas in the op report that show right and left ... frequently using two colors of ink (for example red for Left, blue for Right)

    F Tessa Bartels, CPC, CEMC

  4. #4

    Default Appeal Letter for procedure

    Hi does any one know how can to write appeal letter denial for procedure because didn't obtain prior authorization for procedure, please any one advise, thanks Ana

  5. #5
    Join Date
    Apr 2007


    I would appeal it based on medical necessity.
    Donna Houston CPC
    Medical Biller and Coder
    ICD 10 Proficient

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