Answer:

DATE:

To: NAME OF CONTACT PERSON

INS. CO. NAME & ADDRESS

From: YOUR NAME & ADDRESS

Re: PATIENT’S NAME

DOB (Date of Birth)

Insurance ID#

Dear [NAME],

Thank you for assisting me with [my/my loved one’s] medical care. As you can imagine, this process is very EMOTIONALLY draining on the entire FAMILY. However, the cooperation of the fine staff at [INSURANCE COMPANY NAME] makes it a LITTLE easier.

At this time, I would like to request that [INS. CO.] review the category that [DR. NAME’s] services have been placed into. It appears that I am being charged a copay for [his/her] treatment as a mental health service when in reality [he/she] provides [PATIENT NAME] with pharmacologic management for [his/her] neuro-bio-chemical disorder. Obviously, this is purely a medical consultation. Please review this issue and kindly make adjustments to past and future consultations.

Thank you in advance for your cooperation and assistance.

Sincerely,

[YOUR NAME]

Cc: [list the people in the company you are sending copies to]