How do I appeal a denied dental claim?

1. Read the reason. Your Explanation of Benefits has a code or note explaining the denial, usually in the small print near the bottom.
2. Call the office and ask them to resubmit the claim or file an appeal. Often a resubmission with more information is enough.
3. Make sure it includes what's needed, such as X-rays, photos, or a note from your dentist describing what they saw.
4. Follow up. Ask the office to let you know when they hear back, and watch for a new Explanation of Benefits.

If the office can't help or isn't moving forward, call the member services number on your insurance card and ask what options you have.

Some offices, often ones outside your plan's network, don't deal with insurance, so the appeal is up to you. Your plan may call it an appeal or a grievance.

• Get your records. Ask the office for copies of the X-rays and notes about your treatment.
• Write to the plan. Include your name, member ID, claim number, why you disagree, and the records. A letter from your dentist explaining why you needed the treatment helps.
• Meet the deadline. Your plan sets it, and it's usually listed in the denial notice.
• Keep copies of everything, and write down the date, time, and name of everyone you talk to.

Your denial letter should explain any next steps your plan offers, such as a second appeal or an outside review. You can also contact your state insurance department. It can tell you whether it can help with your plan, or point you to who can.