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ERISA - Sample Appeals Letters

Contents on these pages can be viewed by hovering over the icon to the left of the links with your mouse. They can also be printed.

They can also be downloaded directly, by right-clicking on the link with your mouse and opening to a new window.

Appeal for Billing Problems

Appeal for Medical Necessity

Appeal for Non-Covered Services

Appeal for Non-Formulary Drug

Grievance Letter Against a Professional

How to write a cover letter - Sample Grievance Letter attached

Request for Records - Used to Determine Coverage When an Appeal was denied.

Sample Letter - Failure to Respond to Request for Information