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Date

Employer Street Address City, State Zip

Dear Employer:

I recently received a copy of the [insurance carrier and type of correspondence, i.e. EOB]. I am concerned with the text referenced by [remark code number] printed on the [type of correspondence].

The text referenced by this remark code reads:

“[remark code text].”

This text may imply to the patient that the services rendered were unnecessary or unprofessional. No information was provided to the patient or to me as to why or how this determination was made. Judgments of this kind constitute a diagnosis of the patient’s condition, which cannot be done without examination of the patient by a licensed dentist. Consequently, this message may cause my patient to doubt the appropriateness of this particular procedure. In doing so, it may interfere with the dentist-patient relationship.

As the provider of this dental benefit plan for your employees, I believe that you and your employees expect a benefit plan that meets the oral health care needs of your employees. Plans that deny benefits for treatment deemed unnecessary solely in the opinion of the insurance carrier may not be providing the type of dental care that your employees need and that you and your employees have paid for in premiums.

The American Dental Association recommends that in situations where coverage is not provided by the benefit plan that [insurance carrier] use the following statement in its EOB to the patient in lieu of stating that the services were not necessary:

“This service is not a covered benefit as outlined in the Covered Dental Expense section of your plan. The fee charged by the provider for this service may be your responsibility.”

Additionally, the EOB did not indicate whether or not a licensed dentist reviewed the claim. If a dentist did review the claim, then the name and contact information of the dentist should be provided. This information is necessary so that I may contact the dentist to discuss treatment decisions on a professional level.

I urge you to address this matter with [insurance carrier] as it adversely affects not only my practice and patient, but may also affect your other employees covered by the plan. Thank you for your attention to resolving this concern.

Sincerely,

Dentist

Enclosure