Month Date, Year 

Name of Medical Director
Name of Insurance Company
Street Address
City, State ZIP code 

Dear Name of Medical Director, 

Name of Insurance Company has denied my claim for Name of Therapy/Drug for my Epidermolysis Bullosa. EB-Epidermolysis Bullosa, is a genetic disease where the skin's fragility causes serious wounds all over the body, and there is no cure. Although EB reveals itself on the skin, there is also a significant negative effect on daily functioning associated with this disease. EB patients have esophageal problems, hands web and contract and infection is on-going concern. Epidermolysis Bullosa is a lethal condition, especially with poor treatment of wounds. Without proper treatment, EB is physically and emotionally devastating, preventing the carrying out of most normal activities, diminishing life expectancy. 

My physician and I disagree with your ruling on my case. Please send me information detailing how I can appeal your denial of my physician-prescribed, medically necessary therapy. 

Sincerely,
Patient Name
Patient Address and Phone # 

Cc: Name of patient's physician
HR Director at patient's workplace
Epidermolysis Bullosa Action Network, Advocacy Department