Appeal letter: deep cleaning paid as a cleaning

[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] scaling and root planing, [quadrant(s)] Dear Appeals Reviewer, We are writing to appeal the decision on the claim above, on behalf of our patient [patient name]. The plan paid this service as a routine cleaning. A routine cleaning is not the right treatment for this patient. The enclosed periodontal chart, taken on [chart date], shows pocket depths of [list depths, for example 5 to 6 mm] in the [quadrant(s)] treated, with bleeding on probing and attachment loss. The enclosed X-rays dated [X-ray date] show bone loss in the same areas. Dr. [dentist name] diagnosed [periodontitis stage and grade, or "chronic periodontitis"] and performed scaling and root planing to remove deposits below the gum line and treat the disease. A routine cleaning works above the gum line and would not have treated these pockets. 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: periodontal chart, X-rays, clinical notes, explanation of benefits