Writing a Strong Dental Insurance Appeal Letter (with Sample) Use this sample dental insurance appeal letter as a template for your formal appeal letter.
Dental insurance is typically separate from the medical insurance policy and requires an additional premium. These insurance policies don’t seem to pay what we think they should. Have you recently been denied a claim for work you have had done?
If so, then you need to write a dental insurance appeal letter. Sure you can make a phone call, but who wants to sit on the phone and be transferred over and over again. Still, it is likely the representative will ask you to fill out a form or send it in writing. To write this type of letter, you need to be mindful that you are dealing with a business, and it should be a formal style letter. Before you write this letter, make sure you read your policy and know your rights. Each company has various things they cover and those they will not. You also want to make sure that you are well within your rights to request a second look at the denied charges. You need to know what portion of the policy this denial violates. If you can find it in black and white in their policy, then you have a great chance of getting your claim approved.
Start with standard block format, your name and address, the date and the companies name and address. You may want to add a subject line that includes the reason for the letter and any other pertinent information. Most companies just skim these letters, and you want to make sure they skim the parts you need them too.
The first paragraph should state why you are writing. Lay out the facts. If you have parts of the policy that line up with complaint, then be sure to state the page and any numbers that coordinate with these writings. Also, make sure in the first paragraph to state that you want this item paid, as it is well within your policy to be covered on this item. Include Paperwork
Chances are the company is trying to get you on a technicality. You can include paperwork from the dentist’s office in with the claim, if necessary. Sometimes, it can be a wrong code entered or just an error. However, no matter what the issue you want it taken care of. Dental bills can be large and having insurance that should take care of it and isn’t, can be a pain.
This letter doesn’t have to be long, in fact the shorter the better. The main thing is to get account numbers, policy holder’s names and pertinent information in the letter. This will allow the representative to look up the policy and find the problem quickly. The second or last paragraph should state how they have been good to work with thus far.
Don’t start out negative and demanding in the first letter. Also, this letter is not meant to address issues such as high premiums and how unhappy you are with the company. You just want to stick to the facts. You certainly don’t want someone throwing away your letter just because you have the wrong tone.
Dental Insurance Appeal Letter Sample Note: Make sure to state why you believe they made the wrong decisions. If you need to go out of network to get the services you need, explain yourself well and enclose any documentation necessary. The whole purpose of the letter is to ask for reconsideration. Before drafting a dental insurance appeal letter, make sure to have proper documentation and be ready to answer questions and fill out any packets the insurance company may ask.
Dental Insurance Appeal Letter Sample Kendra Nicely 4027 Doney Street Whitehall, Ohio 43223
DATE 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.