Going to the dentist is never fun, especially when your insurance claim gets denied.
You’re left with a hefty bill and a sinking feeling in your stomach.
But don’t despair!
With a well-crafted appeal letter, you can fight for the coverage you deserve and potentially save yourself a significant amount of money.
In this article, we’ll provide you with 15 sample letters of appeal for dental claims that you can use as templates or inspiration for your appeal.
By the end, you’ll have the tools and confidence you need to challenge your insurance company’s decision and get the coverage you’re entitled to.
Sample Letters of Appeal for Dental Claim
Below are 15 sample letters of appeal for various dental claim scenarios.
Use these as a starting point and customize them to fit your specific situation.
Letter 1: Appealing a Denied Claim for a Routine Cleaning
Subject: Appeal for Denied Dental Claim – Routine Cleaning
Dear [Insurance Company],
I am writing to appeal the denial of my recent dental claim for a routine cleaning. According to my policy, preventive care, including cleanings, is covered at 100%. However, my claim was denied, stating that I had exceeded my annual limit.
Upon reviewing my records, I discovered that this was my first cleaning of the year, and I have not surpassed my annual limit. I kindly request that you reconsider your decision and cover the cost of my cleaning as outlined in my policy.
Thank you for your attention to this matter. I look forward to a prompt resolution.
Sincerely,
[Your Name]
Letter 2: Appealing a Denied Claim for a Filling
Subject: Appeal for Denied Dental Claim – Filling
Dear [Insurance Company],
I recently received a denial for my dental claim related to a filling. The reason given was that the procedure was not medically necessary. However, my dentist determined that the filling was essential to prevent further decay and maintain the integrity of my tooth.
I have enclosed a letter from my dentist explaining the medical necessity of the procedure. Please review this additional information and reconsider your decision to deny coverage for my filing.
Thank you for your time and attention to this matter.
Sincerely,
[Your Name]
Letter 3: Appealing a Denied Claim for a Crown
Subject: Appeal for Denied Dental Claim – Crown
Dear [Insurance Company],
I am writing to appeal the denial of my claim for a dental crown. Your reason for denial was that crowns are not covered under my policy. However, upon reviewing my policy documents, I found that crowns are indeed covered when medically necessary.
My dentist has determined that a crown is necessary to protect my tooth following a root canal. Without the crown, my tooth is at risk of further damage and potential loss. I have included a letter from my dentist detailing the medical necessity of the crown.
Please reconsider your decision and approve coverage for my dental crown.
Thank you for your consideration.
Sincerely,
[Your Name]
Letter 4: Appealing a Denied Claim for a Bridge
Subject: Appeal for Denied Dental Claim – Bridge
Dear [Insurance Company],
I recently submitted a claim for a dental bridge, which was denied because bridges are not covered under my policy. However, my dentist has explained that a bridge is necessary to replace a missing tooth and prevent the shifting of my remaining teeth.
Without a bridge, I am at risk of developing bite issues and further dental problems down the line. I have enclosed a letter from my dentist outlining the medical necessity of the bridge.
I kindly request that you reconsider your decision and approve coverage for my dental bridge.
Thank you for your attention to this matter.
Sincerely,
[Your Name]
Letter 5: Appealing a Denied Claim for a Dental Implant
Subject: Appeal for Denied Dental Claim – Implant
Dear [Insurance Company],
I am writing to appeal the denial of my claim for a dental implant. The reason given for the denial was that implants are considered cosmetic and not covered under my policy. However, my dentist has determined that an implant is the best solution to replace my missing tooth and prevent bone loss.
Without an implant, I may experience a deterioration of my jawbone, leading to further dental issues and potentially costly treatments in the future. I have included a letter from my dentist explaining the medical necessity of the implant.
Please reconsider your decision and approve coverage for my dental implant.
Thank you for your consideration.
Sincerely, [Your Name]
Letter 6: Appealing a Denied Claim for Braces
Subject: Appeal for Denied Dental Claim – Braces
Dear [Insurance Company],
I recently submitted a claim for braces, which was denied because my policy does not cover orthodontic treatment. However, my orthodontist has determined that braces are medically necessary to correct my severe overbite, which is causing jaw pain and difficulty chewing.
Without braces, my condition may worsen, leading to more serious dental and health issues. I have enclosed a letter from my orthodontist detailing the medical necessity of the braces.
Please reconsider your decision and approve coverage for my orthodontic treatment.
Thank you for your attention to this matter.
Sincerely,
[Your Name]
Letter 7: Appealing a Denied Claim for Periodontal Treatment
Subject: Appeal for Denied Dental Claim – Periodontal Treatment
Dear [Insurance Company],
I am writing to appeal the denial of my claim for periodontal treatment. The reason given for the denial was that my policy does not cover this type of treatment. However, my periodontist has determined that this treatment is necessary to address my advanced gum disease.
Without proper treatment, my gum disease may progress, leading to tooth loss and other serious health complications. I have included a letter from my periodontist explaining the medical necessity of the periodontal treatment.
Please reconsider your decision and approve coverage for my treatment.
Thank you for your consideration.
Sincerely,
[Your Name]
Letter 8: Appealing a Denied Claim for Oral Surgery
Subject: Appeal for Denied Dental Claim – Oral Surgery
Dear [Insurance Company],
I recently submitted a claim for oral surgery, which was denied because the procedure was deemed not medically necessary. However, my oral surgeon has determined that the surgery is essential to remove my impacted wisdom teeth, which are causing severe pain and infection.
Without surgery, my condition may worsen, leading to more serious health complications and potentially more extensive and costly treatments in the future. I have enclosed a letter from my oral surgeon detailing the medical necessity of the surgery.
Please reconsider your decision and approve coverage for my oral surgery.
Thank you for your attention to this matter.
Sincerely,
[Your Name]
Letter 9: Appealing a Denied Claim for a Night Guard
Subject: Appeal for Denied Dental Claim – Night Guard
Dear [Insurance Company],
I am writing to appeal the denial of my claim for a night guard. The reason given for the denial was that night guards are not covered under my policy. However, my dentist has determined that a night guard is necessary to address my severe teeth grinding, which is causing tooth damage and jaw pain.
Without a night guard, my condition may worsen, leading to more extensive and costly dental treatments in the future. I have included a letter from my dentist explaining the medical necessity of the night guard.
Please reconsider your decision and approve coverage for my night guard.
Thank you for your consideration.
Sincerely,
[Your Name]
Letter 10: Appealing a Denied Claim for a Dental Sealant
Subject: Appeal for Denied Dental Claim – Dental Sealant
Dear [Insurance Company],
I recently submitted a claim for a dental sealant, which was denied because sealants are not covered under my policy. However, my dentist has determined that a sealant is necessary to prevent decay in my child’s molars, which have deep grooves and are at high risk for cavities.
Without a sealant, my child may develop cavities, leading to more extensive and costly dental treatments in the future. I have enclosed a letter from my dentist detailing the medical necessity of the sealant.
Please reconsider your decision and approve coverage for my child’s dental sealant.
Thank you for your attention to this matter.
Sincerely,
[Your Name]
Letter 11: Appealing a Denied Claim for a Fluoride Treatment
Subject: Appeal for Denied Dental Claim – Fluoride Treatment
Dear [Insurance Company],
I am writing to appeal the denial of my claim for a fluoride treatment. The reason given for the denial was that fluoride treatments are not covered under my policy. However, my dentist has determined that a fluoride treatment is necessary to strengthen my child’s teeth and prevent decay.
Without a fluoride treatment, my child may be at higher risk for cavities and more extensive dental treatments in the future. I have included a letter from my dentist explaining the medical necessity of the fluoride treatment.
Please reconsider your decision and approve coverage for my child’s fluoride treatment.
Thank you for your consideration.
Sincerely,
[Your Name]
Letter 12: Appealing a Denied Claim for a Root Canal
Subject: Appeal for Denied Dental Claim – Root Canal
Dear [Insurance Company],
I recently submitted a claim for a root canal, which was denied because the procedure was deemed not medically necessary. However, my dentist has determined that a root canal is essential to save my infected tooth and prevent the spread of infection.
Without a root canal, I may lose my tooth and be at risk for more serious health complications. I have enclosed a letter from my dentist detailing the medical necessity of the root canal.
Please reconsider your decision and approve coverage for my root canal.
Thank you for your attention to this matter.
Sincerely,
[Your Name]
Letter 13: Appealing a Denied Claim for a Dental Veneer
Subject: Appeal for Denied Dental Claim – Dental Veneer
Dear [Insurance Company],
I am writing to appeal the denial of my claim for a dental veneer. The reason given for the denial was that veneers are considered cosmetic and not covered under my policy. However, my dentist has determined that a veneer is necessary to repair my chipped front tooth, which is causing me pain and difficulty eating.
Without a veneer, my tooth may suffer further damage, and I may require more extensive and costly dental treatments in the future. I have included a letter from my dentist explaining the medical necessity of the veneer.
Please reconsider your decision and approve coverage for my dental veneer.
Thank you for your consideration.
Sincerely,
[Your Name]
Letter 14: Appealing a Denied Claim for Tooth Extraction
Subject: Appeal for Denied Dental Claim – Tooth Extraction
Dear [Insurance Company],
I recently submitted a claim for a tooth extraction, which was denied because the procedure was deemed not medically necessary. However, my dentist has determined that the extraction is essential to remove my severely decayed tooth, which is causing me severe pain and infection.
Without an extraction, my condition may worsen, leading to more serious health complications and potentially more extensive and costly treatments in the future. I have enclosed a letter from my dentist detailing the medical necessity of the tooth extraction.
Please reconsider your decision and approve coverage for my tooth extraction.
Thank you for your attention to this matter.
Sincerely,
[Your Name]
Letter 15: Appealing a Denied Claim for a Dental Inlay/Onlay
Subject: Appeal for Denied Dental Claim – Dental Inlay/Onlay
Dear [Insurance Company],
I am writing to appeal the denial of my claim for a dental inlay/onlay. The reason given for the denial was that inlays and onlays are not covered under my policy. However, my dentist has determined that an inlay/onlay is necessary to restore my damaged molar, which has a large cavity that cannot be treated with a simple filling.
Without an inlay/onlay, my tooth may suffer further damage, and I may require more extensive and costly dental treatments, such as a crown or extraction, in the future. I have included a letter from my dentist explaining the medical necessity of the inlay/onlay.
Please reconsider your decision and approve coverage for my dental inlay/onlay.
Thank you for your consideration.
Sincerely,
[Your Name]
Wrapping Up Your Appeal Letters
Writing an appeal letter for a denied dental claim can be challenging, but it’s a crucial step in getting the coverage you deserve.
By using these sample letters as a guide and tailoring them to your specific situation, you can create a compelling case for why your dental procedure should be covered.
Remember to be polite, concise, and factual in your appeal letter.
Include any relevant documentation, such as letters from your dentist or copies of your policy, to support your case.
Don’t hesitate to follow up with your insurance company if you don’t receive a timely response.
With persistence and a well-crafted appeal letter, you can fight for your rights as a policyholder and get the dental care you need without breaking the bank.