How to Request a Letter for Explanation of Benefits

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You received a mysterious bill pertaining to your hospital visit last month. It has some information about a test that the hospital administered, but you don't understand what the bill means and why the insurance hasn't paid it. Scenarios like this one happen all the time. The best thing to do if you have a question about your benefits is to request an explanation of benefits summary from your insurer. The explanation of benefits statement clarifies the charges and lists what the insurer covered or did not cover.

  • Begin the letter by typing your address. Skip a line, and type the date. Skip another line, and type the name of the insurance company and their claims address. This address is listed on the back of your insurance card.

  • Create the salutation by typing "Dear Sir or Madam" followed by a colon. If you have a dedicated claims agent, type his name instead, but few large insurance companies have dedicated representatives.

  • Start the first paragraph by explaining what you need specifically. Identify yourself by name, insurance ID number, policy number and group number: "My name is Rachel Smith, policy number 45678, group number 78889."

  • Provide the date of service and the name of the clinic or hospital, as well as the bill amount. For example, you might write "I am writing because I received a bill from Community Hospital in San Angelo, Texas, from the dates I was in the hospital, April 12 to April 14. The bill is for the amount of $342.72."

  • Make a direct, specific request for the explanation of benefits. For instance: "I would like to know what this bill was for and why it was not covered by my policy. I would like a detailed explanation of benefits sent to me at the address listed at the top of this letter."

  • Thank the claims representative for her time. Provide your current email address and telephone number in case they need to contact you about the claim.

  • Close the letter by typing "Sincerely," and skip three line spaces. Type your full name. Print the letter and sign your name above the typed name.

References

  • Photo Credit Stockbyte/Stockbyte/Getty Images
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