Sample Appeal Letter for Denial of Periodontal Disease


To Whom it May Concern, 

This letter is to appeal your decision to deny coverage of proper health care for (insert patient name).   As usual with our comprehensive dental examination each tooth had six-point probing and a full mouth series was done.  Staging and grading of the periodontal disease was done using the guidelines established by the American Academy of Periodontology classification system published in 2017.  

 There is calculated attachment loss of 1-2mm on each of the following teeth: (list each tooth CAL) 

(insert patient name) presented with Stage (fill in I, II or III) Grade (A,B,or C)...


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