How to Get Your Doctor to Write a Support Letter for Your Insurance Appeal

When your insurer denies a health, life, or disability insurance claim, one of the most powerful tools in your appeal is a strong, well-written letter from your treating physician. The difference between a vague, one-sentence note and a detailed, clinically specific letter can determine whether your claim is overturned at the internal stage or requires months of ombudsman proceedings.

This guide explains how to ask your doctor for this letter, what it needs to contain, and provides template language your doctor can adapt.

Why Doctor Letters Matter in Insurance Appeals

Insurance companies are not medical professionals — but they rely on medical judgments to deny claims. When the insurer says your condition is pre-existing, not medically necessary, stable, or unrelated to your claim, these are medical conclusions drawn by clinical reviewers who have never met you, worked from paper files.

A letter from your treating physician — someone who has actually examined you, reviewed your complete history, and made clinical decisions for your care — directly challenges the insurer's medical assessment. It is:

• Authoritative: Your specialist's clinical expertise in your specific condition carries more weight than a generic review by the insurer's medical officer
• Personal: It speaks to your specific case, not a general assessment of your diagnosis
• Evidence: It creates a formal, signed document that the insurer must address in any written response and that the ombudsman will consider

Studies and ombudsman body reports consistently confirm that claims supported by specialist physician letters have significantly higher success rates on appeal than claims without them.

Before You Ask Your Doctor

A few things to prepare before approaching your GP or specialist:

1. Read the denial letter carefully and identify the specific medical claims being made. Is the insurer saying:

• Your condition pre-existed the policy?
• The treatment isn't medically necessary?
• You had symptoms before the policy started?
• The condition is stable and doesn't require the requested treatment?
• The treatment is experimental or not standard of care?

The letter from your doctor needs to directly address whichever of these arguments the insurer is making. A general "this patient needs treatment" letter is far weaker than one that responds specifically to the insurer's stated basis for denial.

2. Gather the relevant documents to give your doctor. At minimum:

• Your denial letter (so your doctor understands what they're responding to)
• Your policy number and claim reference
• The name and address of the insurer's complaints department

3. Understand what your doctor can and cannot say. Your doctor can confirm facts about your medical history, their clinical opinion, and their treatment rationale. They cannot make legal arguments or speculate beyond their clinical expertise. Keep the letter in the clinical domain.

How to Ask Your Doctor

Many patients feel awkward asking their doctor to write a letter for an insurance dispute. You don't need to be. Insurers routinely deny legitimate claims, and doctors who treat patients with chronic or complex conditions are often very familiar with this process.

When you ask, be direct and specific:

Say something like: "My insurance claim has been denied. The insurer says [specific reason — e.g., 'my condition is pre-existing' or 'the treatment isn't medically necessary']. I need a letter from you that specifically addresses this claim and explains why their position is incorrect. I can share the denial letter with you so you can see exactly what they're arguing."

Offer to provide:

• The denial letter
• A draft or outline of what the letter needs to cover (use the template below)
• The specific recipient details

Some doctors will charge a letter-writing fee — this is normal. It is a business expense related to your appeal and may be claimable as a consequential cost of the denial in some jurisdictions.

What the Letter Must Include

A strong doctor's support letter for an insurance appeal should cover:

1. Introduction and Relationship

The doctor should introduce themselves, confirming:

• Their name, specialty, and professional registration number
• How long they have been treating you
• The context of the treating relationship (primary care physician, specialist, treating clinician)

2. Diagnosis and Clinical History

A clear statement of:

• Your diagnosis (using correct clinical terminology)
• When you first presented with symptoms
• When the diagnosis was formally made
• The progression of the condition over time

This timeline is critical for pre-existing condition disputes. If the diagnosis was made after the policy start date, the letter should state this explicitly.

3. Treatment Rationale

For medical necessity disputes, the letter should explain:

• What treatment is being recommended
• Why this specific treatment is clinically appropriate for your condition, stage, and circumstances
• What clinical guidelines or published evidence supports this approach
• Why alternatives are insufficient or contraindicated
• What would happen without this treatment (prognosis if untreated, risk of deterioration)

4. Response to the Insurer's Specific Argument

The most powerful letters directly address the insurer's stated denial reason:

• If pre-existing: "I can confirm that [patient] had no diagnosis of, symptoms attributable to, or treatment for [condition] prior to [policy start date]. The condition was first identified on [date]."
• If not medically necessary: "In my clinical opinion, [treatment] is medically necessary for [patient] based on [clinical evidence]. Alternative treatments have been considered and are not appropriate because [reason]."
• If experimental: "This treatment is consistent with [guideline body] guidelines for [condition] and represents the current standard of care. It is not experimental — it is an approved treatment with an established evidence base."

5. Professional Conclusion

A clear statement of the physician's professional opinion and what they are requesting: "It is my professional opinion that the denial of this claim is inconsistent with the clinical facts. I request that the insurer reconsider their decision in light of the medical information provided."

6. Contact Information

The letter should be on official letterhead with the doctor's full name, title, professional registration number, clinic address, phone number, email, and date. It must be signed.

Template Language Your Doctor Can Use

The following is template language your doctor can adapt (you can share this with them):

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[Doctor's Letterhead]

[Date]

RE: Insurance Appeal Support — [Patient Full Name], Policy Number [XXXXX], Claim Reference [XXXXX]

To the Claims/Complaints Manager, [Insurer Name]:

I am writing in support of [patient name]'s appeal against the decision dated [denial date] to deny their claim on the grounds of [reason stated in denial].

I have been [patient name]'s treating [specialty] physician since [date] and have provided their care for [condition] throughout this period.

Clinical History and Timeline

[Patient name] first presented to me on [date] with [description of presenting symptoms]. Following [investigations], I confirmed a diagnosis of [condition] on [date]. Prior to this presentation, there is no record in my clinical files of any symptoms, investigations, or treatment related to this condition. [If relevant: "This diagnosis was made after the policy commencement date of [date]."]

Regarding Medical Necessity

The treatment I have recommended — specifically [treatment] — is medically necessary for [patient name] for the following reasons:

[List clinical reasons, referencing specific clinical findings, disease stage/severity, and prior treatment history]

This recommendation is consistent with [specific guideline body] Clinical Practice Guidelines for [condition], which recommend [treatment] for patients with [patient's clinical profile].

I have considered the following alternatives and determined they are not appropriate for this patient: [list alternatives and specific clinical reasons they are contraindicated or insufficient].

In my professional opinion, failure to provide this treatment risks [state clinical consequence — e.g., disease progression, hospitalisation, irreversible harm].

Professional Opinion

It is my considered professional opinion that the insurer's determination that this treatment is [pre-existing / not medically necessary / experimental] is inconsistent with the clinical facts as I understand them. I support [patient name]'s appeal and request that this claim be reconsidered in light of the clinical information I have provided.

I am available for a peer-to-peer discussion with your medical reviewer if that would assist in resolving this matter. Please contact me at [phone/email].

Yours faithfully,

[Doctor's Full Name] [Title and Specialty] [Professional Registration Number] [Clinic Name and Address] [Date]

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After You Receive the Letter

Once you have the letter:

1. Review it to ensure it addresses the specific denial grounds
2. Include it with your formal appeal letter to the insurer
3. Keep a copy for your own records and for any subsequent ombudsman complaint
4. If the letter is from a GP, consider whether you also need a specialist's letter (for complex medical necessity disputes, a specialist's view carries more weight)

Common Mistakes to Avoid

Not briefing your doctor on the specific denial grounds: A generic letter is far weaker than one that directly challenges the insurer's specific argument.

Accepting a one-line letter: A one-sentence note ("Patient requires this treatment") will not move an insurer. Push gently for a detailed, structured letter.

Not reviewing the letter before sending: Check that it addresses the right issues, contains the correct dates, and doesn't contain any factual errors that could be used against you.

Relying only on a GP letter for a specialist dispute: For complex medical or surgical disputes, a specialist's letter from the relevant subspecialty is more persuasive.

Forgetting to include contact details for peer-to-peer review: Many insurers will request a peer-to-peer call with the treating physician. Offering this proactively signals confidence in the clinical position.

Getting Help

ClaimBack (claimback.app) generates professional insurance appeal letters that incorporate the right framework for presenting your doctor's evidence. The tool is free and helps you structure your appeal letter around your physician's clinical support — making the overall case as persuasive as possible.

Summary

1. Read the denial letter and identify the exact medical arguments the insurer is making
2. Prepare a briefing document for your doctor explaining what needs to be addressed
3. Ask your doctor directly and provide them with the template language above
4. The letter must include: treating relationship, clinical timeline, medical necessity rationale, and direct response to the insurer's argument
5. Review the letter before sending for accuracy and completeness
6. Include the letter with your formal appeal and offer peer-to-peer review availability