Patient Advocacy Letter Templates

Ready-to-use letter templates for billing professionals to hand to patients, enlisting the patient as an ally in the appeal. The patient sends the letter directly, invoking rights they already hold under ERISA §503, MHPAEA, the No Surprises Act (PHSA §2719A), and Medicare regulations. Text in [BRACKETS] must be completed before handing to the patient.

Template categories include ERISA internal appeal letters (invoking 29 CFR §2560.503-1 and the plan's claims procedure), MHPAEA parity demand letters (requiring the plan to produce its Non-Quantitative Treatment Limitation comparative analysis under CAA 2021 §203), No Surprises Act independent dispute resolution letters for surprise billing situations, Medicare Advantage coverage determination and organization determination requests, and prior authorization peer-to-peer review request letters.

Each template includes the applicable regulatory citation, the legal standard the payer must meet in adjudicating the appeal or request, the specific deadlines the plan must comply with, and a disclaimer that the template is an informational resource and does not constitute legal advice. Patients should consult a healthcare attorney or certified patient advocate for guidance specific to their situation.

• MHPAEA parity guide — appeal arguments and enforcement tools
• Appeal Letter Builder — generates complete regulatory-cited letters
• State prompt pay statutes