Concurrent Review Denial Appeal Letter Template

Use this urgent template when your insurer denies continued coverage for treatment already in progress — such as cutting short a hospital stay, ending rehabilitation days, or terminating ongoing therapy.

Concurrent Review Denial Appeal Letter (URGENT)

[Your Name or Patient Representative] [Address] [Date]

[Insurance Company] URGENT — EXPEDITED REVIEW REQUESTED [Appeals Department Address]

RE: Urgent Appeal of Concurrent Review Denial Member: [Patient Name] ID: [Policy Number] Facility: [Hospital/Treatment Center] Current Treatment: [Description] Denial Date: [Date] Continued Stay Denied Effective: [Date]

Dear Appeals Review Committee:

THIS IS AN URGENT APPEAL. I request expedited review under [applicable regulation] as the patient is currently receiving treatment and premature discharge could seriously jeopardize their life, health, or ability to regain maximum function. I also request continuation of benefits during this expedited appeal. 1. Current Clinical Status

The patient is currently admitted at [facility] for [condition/treatment] since [admission date]. As of today, the patient's clinical status includes:

  • [Current vital signs, symptoms, or clinical findings]
  • [Functional limitations]
  • [Why discharge is not medically appropriate at this time]
2. Treating Physician's Assessment

Dr. [Name], the treating [specialty], has determined that continued [inpatient care/treatment] is medically necessary because:

  • [Specific clinical reason 1]
  • [Specific clinical reason 2]
  • [What could happen if treatment is terminated prematurely]
3. Criteria for Continued Stay

The patient meets [InterQual/Milliman/plan-specific] criteria for continued stay because:

  • [Match patient's condition to specific criteria]
  • [Cite clinical indicators that meet medical necessity]
4. Request

I request:

  1. Expedited review within 72 hours
  2. Continuation of benefits during the appeal
  3. Reversal of the concurrent review denial
  4. Authorization for [additional days/sessions as recommended by treating physician]
Sincerely, [Your Name]

Supporting Documentation

  • Attending physician's statement of medical necessity
  • Current clinical records (last 48-72 hours)
  • Nursing notes documenting current status
  • Relevant lab results and imaging

Need Help Writing Your Appeal?

Our AI-powered tool analyzes your denial letter and generates a personalized appeal in minutes. Upload your denial and get started for free.

Start Your Free Appeal

Frequently Asked Questions

What does 'continuation of benefits' mean?

It means your current treatment continues to be covered while the appeal is being reviewed. You must typically request this in writing. Without it, you may be responsible for costs incurred after the denial effective date.

How fast must they respond to an urgent appeal?

For urgent/expedited appeals, the insurer must respond within 72 hours (or less under some state laws). If your health is at immediate risk, emphasize the urgency in your appeal.

Related Resources