Lesikar's Business Communication: Connecting in a Digital World 13th Edition by Kathryn Rentz,Paula Lentz

Exercise 60

You were afraid of this: Your health insurance company has refused to cover the visit you made to a hospital emergency room two weeks ago. You are covered under the company's HMO plan, meaning that, except in emergencies, your healthcare is covered only if you receive it from an approved provider. While the hospital you went to does accept your insurance, the insurance company is claiming that your situation was not an emergency and that you should have gone to one of their doctors' offices instead-which would have been much less expensive. You call the insurance company to explain the facts, and the representative advises you to state your case in a letter to the company's claims department. She says to be sure to include your policy number and the number of the claim. She also advises that you request coverage for both the hospital fee and the emergency-room doctor's fee, since these are two different expenses.
Write the letter that will persuade the company to cover the fees of almost $900. You'll explain that around 8 p.m. of the day you went to the hospital, you had come down with a terrible stomach virus-one that had been going around and had even caused some schools to be closed (it was in the local news). The nausea and diarrhea had been so extreme that you began to get severely dehydrated. At almost midnight, you decided you'd better get to the hospital, so you got your housemate to drive you there. The desk people took one look at you and, after you threw up in the bucket you'd brought with you, had a nurse take you to the treatment area. There you got an antinausea injection and two liters of fluid. The doctor told you that he'd treated several cases like yours and that you were right to come in. You were released at about 6 a.m., still feeling terrible but out of danger. You also had a prescription for antinausea medicine that would see you through the rest of the illness. In light of the circumstances, you don't see what other course you could have taken. Get the insurance company to see it your way.