Dental Insurance Appeal Letter (Free Sample)
Use this sample dental insurance appeal letter as a template for your formal appeal letter.
Dental Insurance Appeal Letter Sample
4027 Doney Street
Whitehall, Ohio 43223
ABC Dental Insurance Partners
9000 Old Church Way
Reynoldsburg, Ohio 43068
Re: Insurance Claim Denial
Dear Sir or Madam,
I am writing about a recent claim that was denied for policy number GB784KI0938. This policy is in my husband’s name, Jake Nicely. The procedure was for myself and it was a root canal and tooth extraction.
While the insurance is covering the tooth extraction, it is not covering the root canal. I have reviewed my policy and see that I am well within my rights to have this covered at 80 percent after my deductible has been met. To date, I have reached my deductible and exceeded its requirements.
According to my declarations page, in section IV, it states that root canals will be covered at 80 percent if the deductible has been met. The letter and bill I received from the dental office says that the insurance company denied the claim.
Can you please check into this for me? I have been a long time member of ABC Dental Insurance Partners and wish to keep my insurance coverage through your company. I can be reached at 555-908-4578.
By Andre Bradley