Free Dental Insurance Appeal Letter [Sample]

Learn how to write a dental insurance appeal letter. Use our sample dental insurance appeal letter as a template for your appeal letter.

Dental Insurance Appeal Letter Template

[Your Name]
[Your Address]
[City, State, Zip Code]


[Director of Claims]
[Name of Dental Insurance Partners]
[Address of Insurance Partners]
[City, State, Zip Code]

RE: Policy Number [NUMBER] appeal for claim denied. Claim number [NUMBER]

Dear [Name of Claims Director]:

I am writing about a recent claim that was denied for policy number [NUMBER]. This policy is in my husband’s name, [Name of Husband]. 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 [Name of Dental Insurance Partners] and wish to keep my insurance coverage through your company. I can be reached at [PHONE NUMBER].


[Your Name]