Sample Letter

To: j.thompson@statehealth.gov

Subject: Request for Reconsideration

Hi Ms. Thompson,

I’m a constituent and a behavioral health case manager from Dothan, Alabama. I am writing to advocate on behalf of a service user who has been denied access to a medically necessary benefit, and I would like to request your assistance in resolving this matter.

The service user, referred to here as Ms. A., recently received a denial for coverage of her outpatient behavioral health therapy. The denial stated that her treatment did not meet the criteria for medical necessity. However, Ms. A. has a documented history of anxiety and traumarelated symptoms that significantly affect her daily functioning. For example, she experiences sudden panic episodes that make it difficult for her to remain at work for a full shift, and she often struggles to complete routine tasks such as grocery shopping or driving due to heightened fear responses. Weekly therapy has helped her regain stability, reduce the frequency of these episodes, and rebuild her confidence.

This denial interrupts a treatment plan that is both clinically appropriate and essential to her progress. Without continued therapy, Ms. A. is at high risk of regression, increased symptom severity, and potential crisis situations that could require emergency intervention. The issue at hand is not simply a paperwork decision — it directly affects her ability to function safely and independently in her community.

I am taking a positive and collaborative approach in requesting your help. I respectfully ask for one of the following outcomes:

· A full reconsideration and approval of Ms. A.’s outpatient therapy sessions, allowing her to continue the treatment that has already proven effective.

· A temporary authorization for a set number of sessions while your office completes a more detailed review of her case.

I am happy to provide any additional documentation or clinical summaries that may support this request. Thank you for your time, attention, and commitment to ensuring equitable access to essential behavioral health services.

Sincerely, [Your Name] Behavioral Health Case Manager