Dental insurance claim denied?
Tell us why it was denied. We'll generate a personalized appeal letter citing the right counter-argument, your appeal rights, and exactly what documentation to attach — for $19.
Common denial reasons we cover
- Not medically necessary
The insurer says the treatment wasn't necessary — common for crowns, deep cleanings, extractions, and periodontal work.
- Frequency limit exceeded
The insurer says you've already used your plan's allowance for this service in the covered period — common for cleanings, X-rays, and periodontal maintenance.
- Code downgraded / alternate benefit applied
The insurer paid for a cheaper procedure than what was actually billed — e.g. paid for a filling when a crown was billed, or a 1-3 tooth scaling instead of 4+.
- Service excluded from the plan
The insurer says this type of service isn't covered under your specific plan at all — worth checking if it was miscategorized before assuming it's genuinely excluded.
- No prior authorization on file
The insurer says this procedure required pre-approval that wasn't obtained before treatment.
- Provider processed as out-of-network
The claim was processed as if your dentist is out-of-network, but you believe they're actually in-network — or you were balance-billed unexpectedly.
This letter states your procedural appeal rights and the standard counter-argument for your denial type — it's paperwork automation, not a legal opinion or a clinical determination. Review it, add any corrections, sign, and send it yourself.
After checkout, you'll enter the details from your denial notice (insurance carrier, claim number, procedure code, and why it was denied).