Skip to main content

APTA has created a variety of template letters you and your patients can use when your patient is denied coverage, the services approved are inadequate, or care is delayed, and a utilization management company is involved.

Commercial Template Letters

APTA Template Letter: Provider to Payer to Request Code Exclusions Policy Change
Use this letter to convey the adverse impact of a coding exclusion on your clinic’s patent population and to request a change in policy.

APTA Template Letter: Consumer to Payer for Denial Based on Code Exclusions
Share this letter with your patients to use in reporting their specific concerns and individual adverse impacts related to a coding exclusion implemented by a health plan.

Templates for Commercial Payer Issues

You can use these letters to request policy changes or address claims denials.

Templates for Prior Authorization Issues

You can use these letters when your patient is denied coverage, the services approved are inadequate, or care is delayed, and a utilization management company is involved.

Templates To Help Your Patients Be Their Own Advocate

Insurance providers are legally required to respond to consumer complaints. These letters should be shared with your patients as a way to communicate with their employers, representatives and officials. Remind your patients that their representatives pay attention when a patient raises a concern!

  • Patients Be Your Own Advocate (Know Your Rights)
    Educate your patients on their rights to health care coverage. If they have been denied services, provide this document as a way to help them appeal to their representative or official. Complete as much of the form as possible, and indicate to your patient what they need to complete.
  • APTA Template: Consumer Letter to Legislator – Basic 
    Share this letter with your patients to use in sending a complaint to their state legislator. They should explain the type of plan they have as well as the difficulties they are having in receiving care.
  • Letter to Legislator Re: Medicaid Benefits Issues with Managed Care Organization
    This letter is for your patients who are Medicaid beneficiaries enrolled in a Medicaid plan administered by a managed care organization, to inform their state legislator that the company the state contracted with to provide Medicaid services is creating barriers to care.
  • Letter to State Medicaid Office (Medicaid beneficiary)
    This letter is for your patients who are Medicaid beneficiaries enrolled in a Medicaid plan administered by a management care organization, to inform their state Medicaid Office that the company they contracted with to provide Medicaid services is creating barriers to care.
  • Letter to Employers
    This letter is for your patients to send to their employers, asking them to intervene when a UM vendor is impeding or denying access to services provided through the company’s health plan.

APTA is here to help! If you aren’t sure where to start in addressing an issue, or when you notice a reoccurring issue, please contact staff at advocacy@apta.org.


You Might Also Like...

News

New Member Benefit a One-Stop-Shop for Prior Authorization, UM Advocacy Tools

Mar 15, 2022

APTA and the Private Practice Section have collaborated to create SPARC — the State Payer Advocacy Resource Center.

Perspective

One-Size-Fits-All Insurance Is Shortchanging Older Athletes

Jan 25, 2022

Health insurance coverage for outpatient musculoskeletal rehabilitation disregards variability in prior level of function, rehabilitation progress, and

Members Only

Payment and Regulatory Update - Dec. 1, 2021

Dec 1, 2021

Topics discussed: Medicare Physician Fee Schedule, Vaccine Mandates, Commercial Payer Updates