You open the insurance EOB, expecting to see a nice juicy payment for that crown you spent an hour perfecting. Instead, you get...
DENIED.

Cue the eye roll, the sigh, maybe even the dramatic forehead-to-desk moment. But here’s the good news:

Denials aren’t the end—they’re just the start of a great comeback story.

You don’t need to take insurance denials lying down. In fact, the appeal process exists specifically for moments like this. And believe it or not, it’s often easier than you think.

Let’s break down the appeal process into simple, stress-free steps—and sprinkle in a little humor while we’re at it.

Step 1: Don’t Take It Personally

First things first—don’t assume the denial means you did something wrong. Insurance companies deny claims for all kinds of reasons:

• Missing X-rays

• Weak or missing narratives

• Wrong codes

• Coordination of benefits issues

• Because it’s Tuesday (ok, not really—but it feels that way sometimes)

It’s not about you—it’s about paperwork. And paperwork can be fixed.

Step 2: Investigate the Denial

Pull out your detective hat and grab the denial letter or EOB. Look for the reason code or explanation.

Common denial reasons include:

• “Not medically necessary” ()

• “Information missing”

• “Alternate benefit applied”

• “Service not covered under the patient’s plan”

Once you know why it was denied, you’ll know how to fight back.

Step 3: Build Your Case (Like a Dental Lawyer)

Think of an appeal like writing a mini legal case—but way less scary. Here’s what you’ll need:

A clear, detailed narrative
X-rays, photos, or perio charting
Any clinical notes from the appointment
A copy of the original claim
A letter of appeal (we’ll get to that next)

Your goal is to prove:

“Yes, this treatment was necessary. Yes, we did everything by the book. And yes, you really should pay us.”

Step 4: Write an Appeal Letter That Gets Attention

Your appeal letter doesn’t have to be long. It just needs to be clear, polite, and persuasive. Here’s a simple outline:

Subject: Appeal for Claim Denial – [Patient Name, DOB, Date of Service]
To: [Insurance Company Name]

Dear Claims Reviewer,

We are appealing the denial of claim #[XXX] for [Procedure] on [Tooth #]. The treatment was medically necessary due to [brief reason—fracture, decay, infection, etc.].

We have attached supporting documentation including:

• Clinical notes

• X-rays

• Narrative

• Original claim

We respectfully request that the claim be reconsidered. Thank you for your time and review.

Sincerely,
[Your Name]
[Practice Name]
[Contact Info]

Boom. Professional and to the point.

Step 5: Send It Off—and Track It!

Send the appeal via the insurance company’s preferred method:

• Online portal (many allow uploads now)

• Fax

• Certified mail (if it’s a big-dollar case)

Always track it. Always log it. Set a reminder to follow up in 2–3 weeks.

Bonus Tip: Don’t Be Afraid to Appeal Twice

Did your appeal get denied again? Appeal again. Include even more evidence. Reference clinical guidelines. You’re allowed to keep pushing back—as long as you're staying professional and organized.

Pro tip: If you're absolutely sure the claim should be covered and they’re still refusing, patients can file a complaint with their state insurance board. That often lights a fire under the payer’s decision-making.

Final Thought: Appealing Isn’t Losing—it’s Winning Smarter

Getting denied doesn’t mean you're out of luck. It just means you're in the appeal zone—and with the right tools, you can win.

Appeals are your practice’s second chance to tell the insurance company:

“Hey, we did the right thing. Now do yours.”

So keep your cool, sharpen those narratives, and appeal like the pro you are. You’ve got this.

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com