Can AI write my health insurance appeal?

The made-up sample:

• [LETTER]Date: September 15, 2024 To: John Doe Member ID: [REDACTED] Claim #: 123456789 Provider: Dr. Emily Chen, MD Service: Inpatient Physical Therapy (CPT 97001) for post‑ACL reconstruction We regret to inform you that your request for inpatient physical therapy is denied. Under Section 12.2 of your PPO plan, inpatient rehabilitation is covered only when a physician documents that continuous, medically supervised therapy is medically necessary and that outpatient services are insufficient. The clinical notes submitted do not meet the required criteria for medical necessity. Accordingly, the claim is denied. If you wish to appeal this decision, you may do so within 180 days of the date of this notice. Please submit a written appeal with supporting documentation as outlined in the attached appeal instructions. Sincerely, HealthCare Insurance Co. Customer Service Department
• [PLAN TEXT]Section 12.2 – Inpatient Rehabilitation Services: Covered only when a physician documents that the patient requires continuous, medically supervised therapy and that outpatient services are insufficient to achieve functional recovery.
• [REASON]Dr. Emily Chen ordered inpatient physical therapy because my knee swelling and limited range of motion after ACL reconstruction have not improved with outpatient sessions, and I risk losing surgical gains without intensive supervised therapy.

• ✓Respond directly to the denial reason
• ✓List required attachments, including a letter of medical necessity
• ✓Tell the user to check the appeal deadline
• ✓Appeal letter under 300 words (191 words, counted by code)
• ✓Didn't make up details we never gave it

What came back (excerpt):

I am writing to appeal the denial of my claim for inpatient physical therapy (CPT 97001) for post-ACL reconstruction, as stated in the denial letter dated September 15, 2024. The denial reason cited was that the clinical notes submitted do not meet the required criteria for medical necessity, specifically that continuous, medically supervised therapy is necessary and outpatient services are insuff

Appeal Letter:

Dear HealthCare Insurance Co. Appeals Department,

I am writing to appeal the denial of my claim for inpatient physical therapy (CPT 97001) for post-ACL reconstruction, as stated in the denial letter dated September 15, 2024. The denial reason cited was that the clinical notes submitted do not meet the required criteria for medical necessity, specifically that continuous, medically supervised therapy is necessary and outpatient services are insufficient.

I would like to provide additional information to support the medical necessity of inpatient physical therapy. My doctor, Dr. Emily Chen, has ordered inpatient physical therapy because my knee swelling and limited range of motion after ACL reconstruction have not improved with outpatient sessions. She believes that intensive supervised therapy is necessary to achieve functional recovery and prevent losing surgical gains.

I have attached a letter from Dr. Chen explaining the medical necessity of inpatient physical therapy, as well as other relevant documents. I believe that this additional information meets the criteria outlined in Section 12.2 of my PPO plan.

Please review my appeal and consider the attached documentation. I would appreciate it if you could re-evaluate my claim and approve the necessary treatment.

Sincerely,
John Doe

Attachment Checklist:
- Letter of medical necessity from Dr. Emily Chen, MD
- Clinical notes from Dr. Chen detailing my condition and treatment
- Relevant medical records, including surgery and outpatient therapy records
- Copy of the denial letter
- Copy of the relevant plan language (Section 12.2)

Please check the denial letter for the appeal deadline, which is stated as 180 days from the date of the notice.

Verify the letter stays under the 300‑word limit and includes all required documents.

The made-up sample (a messier one):

• [LETTER]Date: Oct 10, 2026 Member: Jane Doe Claim #: 123456789 Service: MRI of lumbar spine (CPT 72148) Provider: Dr. Alan Smith, MD Dear Jane, We have reviewed your claim for the above service. Based on our Medical Policy MP-2026-07, the request is denied as Experimental/Investigational. The policy states MRI for low back pain without prior conservative treatment is not covered. You may request a reconsideration by submitting additional medical records. The deadline to appeal is 30 days from the date of this letter. If you have questions, call the Member Services line. Sincerely, HealthFirst Insurance
• [PLAN TEXT]Medical Policy MP-2026-07 – Investigational Services: The plan does not cover diagnostic imaging that is considered experimental, including MRI of the lumbar spine for low back pain unless the patient has completed at least 6 weeks of conservative therapy and there is documented neurological deficit.
• [REASON]Dr. Smith ordered the MRI because Jane has worsening leg pain, numbness, and weakness over the past two weeks, with a positive straight‑leg raise test, and physical therapy has not improved symptoms.

• ✓Respond directly to the stated denial reason
• ✓List the documents to attach, including a letter of medical necessity
• ✓Tell the member to check the appeal deadline in the denial letter
• ✓Appeal letter under 300 words (192 words, counted by code)
• ✓Didn't make up details we never gave it

What came back (excerpt):

Appeal Letter: Dear HealthFirst Insurance Appeals Department, I am writing to appeal the denial of my claim for an MRI of the lumbar spine (CPT 72148) as stated in the denial letter dated October 10, 2026.

Appeal Letter:

Dear HealthFirst Insurance Appeals Department,

I am writing to appeal the denial of my claim for an MRI of the lumbar spine (CPT 72148) as stated in the denial letter dated October 10, 2026. The denial reason stated that the service is considered Experimental/Investigational according to Medical Policy MP-2026-07, as I have not completed at least 6 weeks of conservative therapy.

However, my doctor, Dr. Alan Smith, MD, has documented that I have worsening leg pain, numbness, and weakness over the past two weeks, with a positive straight-leg raise test. Despite physical therapy, my symptoms have not improved. I believe this information is crucial in reconsidering my claim, as it highlights the urgency and necessity of the MRI in diagnosing and treating my condition.

I would like to request that you reconsider my claim based on the additional medical information provided. I have attached a letter from Dr. Smith explaining the medical necessity of the MRI, as well as my relevant medical records.

Please review the attached documents and consider my appeal. I would appreciate it if you could expedite the review process, given the urgency of my condition.

Sincerely,
Jane Doe

Attachment Checklist:
- Letter of medical necessity from Dr. Alan Smith, MD
- Relevant medical records, including documentation of worsening leg pain, numbness, and weakness
- Copy of the denial letter
- Any other relevant documentation supporting the appeal

Please check the denial letter for the appeal deadline, which is 30 days from the date of the letter, to ensure timely submission of your appeal.

Ensure the appeal stays under the 300‑word limit.