Sample Appeal Letter Requesting A Second Opinion
The following form letter requests a specific doctor. By using this technique, you are leaving the door open to some compromise. For example, if the insurer refuses that doctor, the company may suggest another doctor who is outside your doctor's practice. Or you may consider suggesting that the company permit use of a doctor who is part of the managed care company's network, but not part of your doctor's medical group.
Keep in mind that:
- If you are postponing treatment while the appeal is processed, it is important that you follow up promptly and regularly.
- Expedited appeals are generally handled within 72 hours.
If the need for the procedure is urgent, consider paying for it yourself and seeking reimbursement afterward.
Ms. Carol Bress
DeWitt Stern Insurance Company
873 DeKalb Avenue
RE: Policy No. XXXXXXXXXX
Name of Insured: Your Name
Dear Ms. Bress:
Dr. Jekyll has recommended that I have surgery to remove an early stage malignant tumor of the prostate. I am writing to request that a physician outside Dr. Jekyll's medical group confirm the necessity for the surgery.
Dr. Jekyll has offered to have one of his associates give their opinion, but it seems that to get a truly objective opinion of another physician, it would be better to have someone who is not a surgeon and is not associated with my physician give an opinion.
Given the fact that I also have a history of diabetes, it is important that I not be subjected to the stress of surgery unless it is absolutely necessary. I need a second opinion to determine if other treatments would cause less stress on the body than surgery, their effectiveness, and their cost.
I am enclosing an article from the Peer Medical Review that discusses the overuse of surgery and the success of other treatments, such as definitive radiation therapy.
I am requesting that you allow Dr. Kildare, at Metropolitan Medical School, examine my case and give an opinion. Dr. Kildare is a specialist in radiation oncology and is considered one of the most knowledgeable doctors about diseases of the prostate.
Based on these facts, I am requesting that you reverse the opinion of Dr. Jekyll and his medical group and refer me to Dr. Kildare for a second opinion of the advisability of performing surgery on me.
I am also requesting that this appeal be expedited since treatment is on hold until this matter is resolved.