Insurance Appeal Process

Use the information below to learn how to file a dental insurance appeal step by step.

What it means

Filing an appeal with a dental insurance company means you are formally asking them to reconsider and reverse a denial or reduction of benefits on your claim. 

It tells the insurance company you disagree with their decision and want a second, more detailed review.

DETAILS OF AN APPEAL

Second look at claim

  • It is a formal review process where the insurance company looks again at the claim, their notes, and any new information you or your dentist provide.

  • The goal is to show that the treatment is covered under your plan and was necessary for your dental health, so they will pay or increase payment on the claim.

GUIDELINES

Take these steps

  • Review your Explanation of Benefits (EOB) or denial letter to see exactly why the claim was denied or reduced and what the deadline is to appeal.

  • Check the “Appeals” or “Grievance” section on the back of your insurance card, in your benefits booklet, or on the insurer’s website for where to send an appeal (mail, fax, or online portal) and what to include.

  • Gather supporting documents: dentist’s letter, chart notes, x‑rays, photos, the original claim/EOB, and any receipts you paid out of pocket.

  • Submit your appeal in writing (or through the insurer’s online appeal form, if they offer one) and keep copies of everything, including dates and times of any phone calls.

GATHERING INFORMATION

What to say

When writing a letter, email, or message through the insurance portal, patients can keep it simple and clear:

  • Start with:

    • Your full name and date of birth

    • Member ID number

    • Dentist’s name

    • Date of service and the claim number (from the EOB)

  • Then add something like:

    • “I am writing to appeal the denial/reduction of benefits for dental services on [date] with [dentist’s name]. The reason listed for denial is: ‘[insert reason from EOB].’”

    • “My dentist recommended and provided this treatment because [brief medical reason, for example: the tooth had infection, fracture, or decay close to the nerve].”

    • “I am requesting that you reconsider this claim and provide benefits according to my plan. I have attached supporting documentation from my dentist, including x‑rays and clinical notes.”