Need a suitable appeal letter format for the below problem.
To describe the problem, we had submitted the claims correctly, but BCBS has wrongly processed the claims and paid for the DOS. After 30 days, BCBS approached us requesting the refund for the $ amount paid by them. We had sent the first level of appeal to BCBS on 1st week of April 2009. To the appeal letter sent BCBS approached us stating that they need the $ amount by them or will adjust the payment from future claims. My concern is that we had submitted the claim with good faith and as corrected claim, BCBS processed the claim wrongly. So I think we are not liable for processing the claim wrongly. So I'm willing to send a second level of appeal letter to BCBS. I would appreciate, if anyone you would suggest me valuable insurance laws and points or appeal format that can be sent to BCBS.
Dr.