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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.

APTA Template Letter: Provider to Payer to Request Reconsideration of Adoption of PTA Payment Differential
Use this letter to convey the adverse impact of the PTA payment differential on access to care for your clinic's patent population and to request a change in policy.

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!

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.


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