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Appeal Letter: MRI Denied by Insurance

Use this appeal letter template when your insurer denied coverage for an MRI scan due to prior authorization requirements or medical necessity.

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Key Arguments to Make

  • ✓MRI is a standard diagnostic tool recommended by clinical guidelines for the presenting diagnosis
  • ✓The treating physician has documented medical necessity based on symptoms and failed conservative treatment
  • ✓Denial of MRI delays diagnosis of potentially serious conditions
  • ✓Alternative imaging (X-ray, ultrasound) cannot provide equivalent diagnostic information for this indication

Appeal Letter Template

Customize the sections below with your personal details. Replace text in [brackets] with your information.

Sample Appeal Letter — MRI ScanPersonalize This Letter →
To: [Insurance Company Name], Appeals Department
Re: Appeal of Claim Denial — [Your Name] — Member ID: [Member ID]
Date: [Today's Date]
Opening

I am writing to formally appeal the denial of coverage for an MRI scan ordered by [Provider Name] on [Date]. The denial reference number is [Denial Reference]. I believe this denial was made in error and request immediate reconsideration.

Medical Necessity Statement

The MRI was ordered to evaluate [Diagnosis/Symptoms]. My treating physician, [Provider Name], has documented that this imaging is medically necessary to [specific clinical reason]. Conservative management with [prior treatments] has not resolved my condition.

Clinical Support

The American College of Radiology Appropriateness Criteria and [relevant specialty guideline] support MRI as the appropriate imaging modality for my presenting condition. I have enclosed supporting clinical documentation.

Closing

I respectfully request that you reverse this denial and approve coverage for the MRI scan. I am available to provide any additional information required. If this internal appeal is denied, I will request an Independent External Review as provided under ACA §2719.

Sincerely,
[Your Name]
[Phone] · [Email]

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