Appeal letter: perio maintenance paid as 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] periodontal maintenance, date of service [date] 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 as a routine cleaning / denied it as having no prior periodontal treatment]. The patient had scaling and root planing on [date or dates] at [office name], [paid by another insurer, if so]. The enclosed records show it. Since then, the patient has been on periodontal maintenance every [interval] to keep the disease under control. The enclosed chart from [date] shows [pocket depths and findings]. 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: scaling and root planing record, periodontal chart, explanation of benefits