Document background
The Health Insurance Appeal Letter is a crucial document used when an insurance provider has denied coverage for medical services in Nigeria. It serves as a formal mechanism for policyholders to challenge claim denials under the framework established by the National Health Insurance Act 2022 and supervised by the NHIA. This document should be submitted within the specified appeal timeframe (typically 30-60 days from denial) and must include comprehensive information about the denied claim, medical necessity documentation, and relevant policy provisions. The letter is particularly important in cases involving disputed medical necessity, out-of-network care, emergency services, or procedural errors in claim processing. It represents a key step in the appeals process before considering other remedies such as regulatory complaints or legal action.
