NEDA TOOLKIT for Parents
Sample Letter #2
The need to flex hospital days for counseling sessions. Remember, just because you are using outpatient services
does not mean that you cannot take advantage of benefits for a more acute level of care if your child is eligible
for that level of care. The insurance company only knows the information you supply, so be specific and provide
support from the treatment team!
Outcome 10 Hospital days were converted to 40 counseling sessions.
Date: To: Name of an individual in the Ins. Co. Management Dept
INS. CO. NAME & ADDRESS
From: YOUR NAME & ADDRESS
Re: PATIENT’S NAME
DOB (Date of Birth)
Insurance ID#
Case #
Dear [insert name]:
This letter is in response to [insurance company name’s] denial of continued counseling sessions for my [daughter/
son]. I would like this decision to be reconsidered because [insert PATIENT NAME] continues to meet the American
Psychiatric Association’s clinical practice guidelines criteria for Residential treatment/Partial hospitalization. [His/
Her] primary care provider, [NAME], supports [his/her] need for this level of care (see attached – Sample Letter #3
below provides an example of a physician letter). Therefore, although [he/she] chooses to receive services from
an outpatient team, [he/she] requires an intensive level of support from that team, including ongoing counseling,
to minimally meet [his/her] needs. I request that you correct the records re: [PATIENT NAME’s] level of care to
reflect [his/her] needs and support these needs with continued counseling services, since partial hospitalization/
residential treatment is a benefit [he/she] is eligible for and requires.
I am enclosing a copy of the APA guidelines and have noted [PATIENT NAME’S] current status. If you have further
questions you may contact me at: [PHONE#] or [Dr. NAME] at: [PHONE#].
Thank you in advance for your cooperation and prompt attention to this matter.
Sincerely, [YOUR NAME]
Cc: [Case manager]
[Ins. Co. Medical manager]
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