Sample Insurance Denial Board Complaint Letter

(DATE)

Today my patient (NAME) was denied care by their insurance company (INSURANCE).

In my medical opinion the care I recommended was appropriate for my patient’s condition and I believe that any two of my colleagues who reviewed the case would agree.

I believe the denial of appropriate care for my patient constitutes malpractice.

If there was no physician involved in the decision to deny care, then the insurance company is making medical decisions without a license to practice medicine and the case should be referred to the Nevada Attorney General’s office to prosecute the insurance company for the unlawful practice of medicine.

If a physician was involved in the decision, they are in violation of NRS (630.301(8)). Nevada case law affirms that their medical opinion constitutes the practice of medicine.

A copy of my clinic note documenting the plan for the care is attached.

Brief details are given below. (1-4 sentences max)

Respectfully,

___________________