Letter to Complain about Surgery not Covered by Insurance

Disputes between the insurer and policyholders are something very commonly heard. The most common among them is when the company reimburses, and the policyholder does not find the reimbursement satisfactory. This could happen because of a mistake on the part of the company, or the policyholder might have failed to understand the actual clauses and conditions of the policy, etc. Nonetheless, it is the due right of the policyholder to submit a complaint if he is not satisfied with what he is reimbursed.

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I am writing to place a complaint about your company’s recent denial of covering my medical bills. I had an accident and broke my arm about two weeks ago. I had to undergo surgery to have it fixed which cost me around ten thousand dollars. I am availing of your Premium Health Insurance policy number 389-342-918 and one of its clauses states that your company shall fund eighty percent of the medical bills in case of surgery.

Now when I contacted your company on call yesterday, I was told by one of your representatives that only those surgeries will be covered by your company which is needed due to natural causes such as a disease or genetic disorder. Any injuries caused by accidents that require surgery shall not be covered by this insurance plan.

If there were any such conditions on the insurance clauses, I should have been informed earlier so I could have considered my options carefully.

I am not happy with the service your company is providing as it is very unprofessional to conceal important information from the clients.

I request you to please get in touch with me immediately to sort this matter out. In case there has been a mistake at your end and your representative miscommunicated the information, please let me know so we can start the reimbursement formalities.

Thank you and regards.

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Good day. I am writing to make a complaint about my surgery not being covered by the insurance plan I am currently availing myself. I have written letters to your company representatives twice, but my claim was rejected both times. I recently underwent a spine correcting surgery which cost me about twenty-five thousand dollars.

My spines curvature was affected due to an accident I had two weeks ago, and this surgery was recommended and performed by Dr. Gustavo Johnson at the Primary Healthcare Hospital. I have attached my medical reports and hospital bills with this letter.

I am currently availing of your premium insurance plan which covers my medical bills of up to a hundred thousand dollars. I gave all this information to your company and made a claim as your company is liable to pay my surgery bills.

My claim has been rejected twice and I wasn’t given any explanation for it either. I can provide proof of all the communication that happened between us. I request you to please investigate this matter and kindly explain to me why my claim was rejected.

Furthermore, if surgery is not covered by this insurance plan, I should’ve been made aware of it before I signed up for it. As a client, it is our right to know all the clauses and it is unfair to conceal important information from us.

I hope to hear from you on this matter as soon as possible as it has caused me a lot of distress.

Thank you and regards.

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Dear [Recipient’s name],

I am writing to you regarding my health insurance with you the policy number of which is #123456. After an accident last month, I had claimed insurance. The accident was severe and I remained admitted to the hospital for almost three weeks. Since my legs were badly hurt and some metallic pieces went into some parts of my body during the accident I also had to go through surgery on my legs for that purpose.

All the essential documents and details were provided when I made the insurance claim. The mention of surgery and its expenses was also made clear. I received the settlement letter yesterday and I am astonished to see that the expenses of surgery are not included in the letter.

I am uncertain if this is done mistakenly or according to some policy. As far as I know, my policy says that the company is responsible for reimbursing 100% in case a health issue arises. Since no exceptions were mentioned in the policy, I thereby, am complaining to you regarding this injustice.

I expect 100% reimbursement and therefore, request you to contact me at the earliest to resolve this dissatisfaction. I am otherwise thinking to cancel my insurance with you. Thanks!