Appeal letter: crown replaced too soon

An appeal letter template for a crown, bridge or denture the plan denied because the old one was placed within its replacement window, often 5 years.

Updated November 11, 2026

The denial

The plan denied the new crown, bridge or denture because the old one was placed less than the allowed number of years ago, often 5.

Why plans deny it

Plans pay to replace a crown, bridge or denture only once in a set period.
The plan's records show an earlier placement date than the real one.

Is it worth appealing?

Worth appealing when the plan has the wrong placement date, or when the old crown failed for a reason the plan makes an exception for, such as the tooth breaking or new decay. Many plans make no exceptions.

What to send with the letter

The record of when the old crown, bridge or denture was placed
X-ray and photo showing why it failed
Clinical notes
A copy of the explanation of benefits

The letter

Paste it into your own letterhead and fill in the [brackets]. This page has no fields: nothing about the patient is typed here.

[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 / bridge / denture], 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 replacement because the existing [crown / bridge / denture] was placed within the plan's replacement period. [Pick one: Our records show it was placed on [date], more than [years] years before this service. / The tooth under it has [new decay / a fracture] that the old crown can't be repaired around, as the enclosed X-ray and photo show.] [If the plan allows exceptions:] We ask the plan to review this under its exception for [the reason in the plan's documents]. 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: placement record, X-ray, photo, clinical notes, explanation of benefits

Before you send it

Send it before the deadline. The denial notice has to say how long you have and how to appeal. Employer plans that follow federal benefit claim rules give at least 180 days.
Send it to the appeals address or fax on the explanation of benefits, not the claims address.
The patient, or someone they authorize, has the right to appeal. Offices often send it for the patient; some insurers first ask for the patient's signed authorization form.
Keep a copy of everything you send and the date you sent it. If the appeal is denied, the plan has to explain why in writing.

For how plans pay this service and what to check before treatment, read the crowns billing guide.

A starting point, not legal advice. The plan's documents and the insurer decide what's paid.

CDT is a registered trademark of the American Dental Association. Tabruns is not affiliated with or endorsed by the ADA. The descriptions here are our own plain-English summaries, not the ADA's official wording; use your current CDT manual or practice software for the official code set.

Sources

Read November 11, 2026. Where a source describes one insurer's plans, we say so.

Get the patient's share in dollars, from the benefits page

Most of these denials can be seen coming from the benefits page. Tabruns reads the coverage, deductible, yearly maximum, waiting periods and frequency limits from the insurer's portal and works out what the patient owes. Patient details stay on the office computer.

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