Appeal letter: crown denied as not necessary

[Office name] [Office address] [Office phone] | [Office email] [Date] [Insurer name], Appeals [Insurer appeals address or fax] Re: Appeal of claim [claim number] Patient: [patient name] | Member ID: [member ID] | Date of birth: [date of birth] Subscriber: [subscriber name] | Group: [group number] Date of service: [date of service] | Procedure: [code] crown, tooth [tooth number] Dear Appeals Reviewer, We are writing to appeal the decision on the claim above, on behalf of our patient [patient name]. The plan denied this crown as not necessary. On [exam date], Dr. [dentist name] found [describe: a fractured cusp, a crack under an old filling, recurrent decay under a large filling] on tooth [tooth number]. After the old filling and decay were removed, about [percent] of the tooth's structure was left, too little to hold a filling. A filling would leave the remaining walls unsupported and at risk of breaking, which could mean losing the tooth. The enclosed photo shows [what it shows], which an X-ray can't show. A crown was the treatment that protects the tooth. Please review the enclosed records and reprocess the claim for payment under the patient's benefits. If you need anything else, call [contact name] at [phone]. Sincerely, [Dentist name], [DDS or DMD] NPI [NPI number] Enclosures: intraoral photo, X-ray, clinical notes, explanation of benefits