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Copyright Question about Letters

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I reside and work in Florida. I do Medical Billing and one task is to appeal health insurance denials. To do this, appeals letters are written, based on the type of denial. I have been doing this for more than 7 years. Over the years, these letters have been changed to reflect research performed by me on the particular subject, changes in statutes, administrative codes, etc. and they are re-worded gramatically to become more successful with the appeal. They also change each time, adding patient information and treatment that is pertinent to the appeal. My colleagues have asked for copies of these letters and naturally, I tell them that the letter will need to be changed to reflect their local laws.

A company has created a set of health insurance claims denials appeals letters. The binder they come in states they are copyrighted. These are business form letters that the user must change the header, date, adds a personal closing line and signature block, etc.

I purchased these letters on or about October 2000 to see how close they were with mine. Some of the letters are similar in wording to ones I created years before. After all, when telling an insurance company what the State Statutes says, there are only so many ways to word it, especially when quoting the statute.

One letter I used was in regards to insurance companies requesting refunds several years after making payment. I conducted extensive research, read my state's laws,and came up with a letter that works. Their letter mentions the word "laches" and no state law. Mine mentions the legal definition of the Doctrine of Laches and my state's statute regarding this issue. My letter also mentions what we did prior to sending the claim, their letter does not. The wording of both letters are similar but not identical. Their letter is brief, mine is a little lengthy because I add more detail.

On a similar question and answer forum such as this, a fellow colleague posted a problem along these lines. I responded with how I sucessfully handle this problem, and that I offered my refund letter to her, without compensation. About 5 people responded also asking for a copy of my letter.

An attorney that sells Health Information Newsletters saw the postings and sent copies of the e-mails to the owner of the appeals letters company. The owner asked to see a copy of my letters and then told me I should not be giving away her letter. I stated mine was not the same as hers. On a side note, the attorney directed everyone in the forum to go to her website and they could download the same, identical,appeals letters company letter, for free from her website. She also has the same letter included in one of the newsletters you can buy from the company she represents. The appeals letters company also has a website and you can also download the same letter there. So, this letter is free to internet users and another person, other than the company that is selling the letters, is also making money by reselling the letter in a newsletter subscription. Yet, I am the one being crucified by helping friend with a letter I created and that is not the same letter.

Now, in my opinion,I purchased these letters, therefore I own them. These letters cannot be used as is. They must be changed each time to reflect the patient's/provider's situation. If these letters are available in a public domain area, such as the internet, am I violating copyright laws if I want to give the same identical letter, that I bought and own, to a friend, if no compensation is received.

Now, if I bought these letters, and I am not pleased with the wording, or I feel the information is insufficient and I want to add a paragraph, or the statute regarding the subject has changed, do I have the right to make these changes/additions to the letter, or even create a new letter incorporating parts of the original letter with new information, and am I violating copyright laws and if a friend asked me for a copy of the new letter and I sent it, with no thought of reimbursement, am I violating any copyright law and if this friend has to change the letter due to their state laws, are they violating the copyright of the original letter?

Lastly, If my letter is similar, not identical, to theirs, yet, I created mine long before purchasing theirs, does my letter violate the copyright of their letter?



Senior Member
Yours is an EXCELLENT set of questions that I can't begin to fully answer. Look at FreeAdvice.com under copyright for the basics first. The fact that you bought the book does NOT give you the right to copy it and distribute it on the street to others. For example, I can't buy a copy of Gone With the Wind and sell millions more, or make derivative copies of it.

Now if and to the extent that you created YOUR letter first, it is yours and that they may have created the identical one later does not give them the exclusive right to control it. Also, if and to the extnet the letter mererly recites the law, or is not an "original work" requiring creativity, it is not a subject for copyright protection.

If you merely made minor changes to their copyrighted material it would be a derivative work and not impact the fact that they hold the copyright on it.

But of more significance is that if they sold the book one could assume they did so with the intent that it be used as a model for the purchasers (why else would someone buy it?). Thus if you bought it and used it like they intended I am not sure what their complaint is.

I can see why they don't want you to give away to others even 1 page of what they sell for money.

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