Appeal letter sample: Capsule Endoscopy


Template letter for professionals to complete so patients may undergo a capsule endoscopy for diagnostic purposes instead of other methods of examination. Healthcare provider completes letter and patient submits to their insurance company prior to testing.



For further information, call the Irwin M. and Suzanne R. Rosenthal IBD Resource Center (IBD Help Center): 888.MY.GUT.PAIN (888.694.8872).

The Crohn’s & Colitis Foundation of America provides information for educational purposes only. We encourage you to review this educational material with your health care professional. The Foundation does not provide medical or other health care opinions or services. The inclusion of another organization’s resources or referral to another organization does not represent an endorsement of a particular individual, group, company or product.

About this resource

By: CCFA
Published: May 1, 2012

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Capsule Endoscopy (.doc)
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