Health Insurance Carriers Editing and Proofreading Services

A member opens a letter that says their request has been denied as not medically necessary under the terms of their plan, and refers them to section 7.4. They do not know what was denied, who decided, what would have made it approvable, or what to do next. What they do next is telephone, complain, and tell everybody — and every one of those costs more than the letter would have.

We edit what health insurers produce — coverage determination and denial notices, explanations of benefits, appeal rights and internal review information, prior authorisation requirements and their explanations, plan summaries and benefit descriptions, member correspondence about network and cost changes, and provider-facing policy communications. Our editors work on letters that arrive when somebody is already ill.

The denial notice is the most consequential letter a health insurer sends, and its failure is a decision stated without the reasoning or the route. A member who cannot understand a denial cannot appeal it, and an appeal is often what the process expects them to do. We work through these so the letter names precisely what was requested and by whom, since a member frequently does not know what their consultant asked for and cannot recognise it from a code; so the reason is given in a sentence a person can act on rather than as a criterion reference, because "not medically necessary" describes a conclusion and "our criteria require three months of physiotherapy to have been tried first, and the records we received show six weeks" describes a gap that can be closed; so the specific missing information is listed where the denial is evidential rather than clinical, given that a substantial share of denials are administrative and are resolved by one document; so the appeal route is set out with the deadline, what to send, where to send it and how long a decision takes; so the expedited route is explained where the situation is urgent, as a member in pain needs to know that a faster path exists; so the reviewer's qualification is stated, since a member is entitled to know a clinician was involved; so what the member will owe if they proceed anyway is stated in money; and so the letter is written at a reading level somebody can manage on a bad day. Notices written this way reduce complaints and produce better appeals.

Everything you send is treated in confidence, including member information, clinical criteria and appeals correspondence. We are editors rather than clinicians, regulators or benefits advisers, and we offer no view on medical necessity, coverage or any determination. What we can do is make the decision understandable and the next step obvious.