Have you paid a visit to the dentist lately only to end up with a hefty bill for treatment that should have been covered under your plan? To avoid sitting on the phone debating with a call center representative, it may be time to compose a letter of appeal to your dental insurance provider to sort things out. Before you get started, be sure to thoroughly review the policy to ensure the items in question are eligible for inclusion under your plan.
What to Include
There are three essential components that should be included in your letter of appeal.
In the top left corner of your letter, be sure to include the following information:
- Your name and address
- Date of the letter
- Insurance provider's name and address
- Claim number
You also want to include the reason for your letter at the top of the page so that it can be routed to the correct department or individual within the insurance company. Before submitting, review this information carefully as it may be used by the customer service representative to positively identify you.
The body of your letter should once again state your name, claim number and reason for the letter. In addition, it should contain a thorough explanation of the discrepancy and the reason why their decision is incorrect by disclosing the eligible coverages under the appropriate section from the declarations page.
Toward the conclusion of the letter, kindly request that they look into the matter. Provide your phone number in case they need to contact you with additional questions or concerns. Also, reiterate that you are pleased with the company and that you have been a loyal customer and are seeking that the error be rectified so that you will not be set back financially.
It's also a good idea to include any supporting documentation, including the original claim paperwork, from the dental office so that the examiner can have a thorough understanding of the situation. The solution may be as simple as a transposed number, incorrect code or typographical error.
Tone of the Letter
Use a formal but concise tone when composing your letter. Representatives tend to skim these letters as a result of sheer volume. Also, be sure to follow the format in the samples listed below so that the representatives will easily be able to locate the information they need to research your request.
Tips for Following-Up
If a substantial amount of time lapses before you receive a response, do not hesitate to give your insurance provider a call to inquire about the status. You can also fax a copy of the original letter and supporting documentation over or submit an appeal via their website if available. As a last resort, request that your dental office submit a letter of appeal on your behalf.