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Need appeal letter format


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.


In my experience, even though you are appealing the claim you need to refund the $ to prevent penalties, retractions from future billings, etc.  In the meantime you appeal the claim and when/if they reverse their decision they will reissue the money.

The appeal letter does not have to be fancy.  What you put below is almost clear enough.  Just state the facts and the reason you disagree with their decision to retract the $.

Good luck


LOL, Michelle I just replied the same answer in another forum they posted this in. Great minds!!
Yes its better to just refund them as you fight for it back in the appeals process. Holding on to it won't do you any good. They will simply TAKE it off another claim.



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