Received a denial letter? Use this tool to generate a formal appeal based on IRS regulations. Select the reason for denial below to auto-fill the legal language.
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Date:
To: (Appeals Department)
RE: Claim Denial Appeal
Employee Name:
Claim Number:
Date of Service:
Amount: $
To Whom It May Concern,
I am writing to formally appeal the denial of the claim referenced above for services/products provided by .
The denial reason stated was: .
However, this expense is eligible for reimbursement under my plan and IRS regulations for the following reason:
I have attached the required documentation to substantiate this claim. Please review this information and process the reimbursement immediately.
Sincerely,