An appeal letter for scaling and root planing is a letter that is written to request reconsideration of a denied dental insurance claim for the procedure.
It is important to follow the guidelines and requirements of the insurance company when writing an appeal letter.
Here is a sample appeal letter for scaling and root planing:
Sample Dental Appeal Letter for Scaling and Root Planing
Dear [Insurance Company],
I am writing to appeal the denied claim for my scaling and root planing procedure that took place on [Date] at [Dental Office].
I understand that the procedure is considered to be cosmetic and therefore not covered under my insurance plan. However, the procedure was not solely for cosmetic purposes.
The scaling and root planing was recommended by my dentist due to [Reason for Procedure], and it was necessary for the maintenance of my oral health.
I have included copies of the following documents with this letter:
- Explanation of Benefits (EOB) form
- Dental Office billing statement
- Dental Office treatment plan
- Letter from my dentist explaining the medical necessity of the procedure
I respectfully request that you reconsider your decision and cover the cost of the scaling and root planing procedure. I appreciate your consideration and look forward to your response.
NOTE: It is important to provide clear and detailed information in the appeal letter, including the date of the procedure, the dental office where it took place, and the reason for the procedure.
It is also helpful to include any supporting documents, such as an Explanation of Benefits form, billing statement, treatment plan, and a letter from the dentist explaining the medical necessity of the procedure.
Frequently Asked Questions (FAQs)
1. What is the process for appealing a denied insurance claim for scaling and root planing?
Answer: The process for appealing a denied insurance claim for scaling and root planing typically involves writing a letter to the insurance company, providing additional information or documentation, and potentially going through a review process with the insurance company.
2. How do I write a letter to appeal a denied insurance claim for scaling and root planing?
Answer: In your appeal letter, include the following information:
- Reason for the procedure
- Explanation why it is medically necessary
- Request for reconsideration
- Supporting documentation (e.g. dentist recommendation)
- Contact information for follow-up
3. What documentation should I include in my appeal letter for scaling and root planing?
Answer: You should include any relevant documentation from your dentist, such as a recommendation for the procedure, information about your periodontal condition, and any other supporting medical records.
4. Is it possible to get an insurance claim for scaling and root planing approved on the first appeal?
Answer: It is possible, but not guaranteed. Each insurance company has its own processes and criteria for determining coverage, and there is no guarantee that an appeal will be approved.
5. What if my appeal is denied after the first review?
Answer: If your appeal is denied, you can write another letter to request a higher level of review, or you can consider filing a complaint with your state’s insurance department.
6. Can I get assistance with my appeal?
Answer: Yes, you can get assistance with your appeal. You can speak to your dentist, a patient advocate, or a lawyer for advice on the appeal process and to help you draft a strong appeal letter.