Our sample letters help you appeal insurance denials

FORCE has created sample appeal letters for a variety of screening and preventive services as well as treatments needed by members of our community. Simply click on the link to download the letter template in a Microsoft Word file.

It is important that you personalize the letter to include details about your unique circumstances and include supporting documentation such as genetic test results, doctor's notes, etc. to make a solid case for approval. You should also ask your healthcare provider (surgeon, oncologist, etc.) to submit an insurance appeal on your behalf or to write a letter of medical necessity which you can include with your written appeal.

Need help with an appeal for a service or situation not listed? Email us for assistance.

Genetic Services

• BRCA counseling and/or testing - women
• BRCA counseling and/or testing - men

Cancer Screening

• Breast screening MRI - women with BRCA mutation
• Breast screening MRI - women with mutation other than BRCA
• Breast screening MRI - women with 20% or higher risk (no known mutation) 
• Colonoscopy - people with Lynch syndrome
• Mammogram - women with BRCA mutation
• Mammogram - women at increased risk of breast cancer (no genetic testing or no genetic mutation found)
• Ovarian cancer screening - women with BRCA mutation
• Prostate cancer screening - high-risk men
• Pancreatic cancer screening - high-risk individuals

Surgery

• Breast reconstruction after mastectomy
• Breast reconstruction revisions
• Explant surgery (removal or exchange of breast implants due to recall)
• Breast reduction/lift in preparation for nipple-sparing mastectomy
• Risk-reducing salpingo-oophorectomy (removal of ovaries and fallopian tubes)
• Risk-reducing bilateral mastectomy - BRCA mutation carrier
• Risk-reducing bilateral mastectomy - ATM, PALB2, CDH1, CHEK2, Lynch or other mutation
• Risk-reducing bilateral mastectomy - High risk, no mutation found