Prior-authorization denial appeal

{{your_name}} {{your_address}} {{insurer_name}} Appeals Department Re: Appeal of prior-authorization denial - member {{your_account}}, claim {{claim_or_invoice}}, date of service {{visit_date}} To whom it may concern, I'm formally appealing your denial dated {{denial_date}} of the above claim, which cited "no prior authorization on file" as the reason. This denial is incorrect. Prior authorization for this service was obtained on {{prior_auth_date}}, authorization number {{prior_auth_number}}. This was completed before the date of service in compliance with my plan's pre-service requirements. The authorization is on file in your system and I'm including a copy of the confirmation with this letter. Per ERISA § 503 and 45 CFR § 147.136, you are required to provide a full and fair review of this appeal and issue a written decision within 30 days for a pre-service denial or 60 days for a post-service denial. I'm requesting: 1. Reversal of the denial and payment of the claim consistent with the prior authorization. 2. Written confirmation of the corrected adjudication. 3. If you uphold the denial, a copy of the specific plan-document language and clinical rationale you relied on. If this is not resolved at the internal-appeal level, I will exercise my right to external review. Sincerely, {{your_name}}