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Draft the insurance appeal before the deadline passes

Today

A crown comes back denied. The justification is in the chart, the denial letter is sitting on the counter, and writing the appeal keeps sliding to the end of the day until the filing window is gone.

With Claude

You paste the redacted denial language and the clinical facts, and Claude returns a structured appeal that quotes the carrier back and answers each point against the documentation you already have.

The prompt

Paste this into claude.ai and replace anything in brackets.

You are helping a dental practice appeal a denied insurance claim. Work only from the facts I give you. Never invent clinical findings, dates, or documentation that I did not state.

The carrier's denial language, with patient identifiers removed:
[paste the stated denial reason and any code the carrier cited]

The procedure and its clinical justification, de-identified:
[paste the procedure name or CDT code, the tooth number, the findings that supported it, and what documentation exists, such as radiographs, perio charting, photos, or a prior narrative]

What we submitted with the original claim:
[list it]

Write a one page appeal letter addressed to the carrier's dental consultant, structured as:
1. A claim reference block with bracketed blanks for claim number, date of service, and member ID so we fill those in ourselves
2. One sentence stating what we are appealing
3. The carrier's stated reason, quoted
4. A point by point response using only the facts above, with each point tied to the specific documentation that supports it
5. A short closing that requests reconsideration and lists the attachments

Keep it factual and unemotional, and use the carrier's own vocabulary where I gave it to you. At the end, under a heading called Gaps, list anything you would have wanted that I did not provide.

What to skip in dental practices

  • Anything with protected health information in it. Do not paste patient names, dates of birth, chart numbers, radiographs, or exports from your practice management software into claude.ai on a Free, Pro, Max, or Team plan. Anthropic's Business Associate Agreement covers HIPAA-ready services such as Claude Enterprise with HIPAA compliance activated by the Primary Owner, and the first-party API, and those consumer plans sit outside that coverage. Work from de-identified summaries and templates until a signed BAA is actually in place.
  • Clinical diagnosis and treatment decisions. Claude is not a medical device and is not cleared for diagnosis. Do not ask it to read a radiograph, stage periodontal disease, choose between restorative options, or decide whether a tooth is restorable. The dentist diagnoses and the dentist owns the plan. Claude only helps explain a plan a clinician already made.
  • Sending anything to a patient or a carrier unread. Post-op instructions, appeal narratives, and treatment explanations all carry professional liability, and a draft that reads well can still be wrong. A licensed clinician approves every word before it leaves the office.

Want all 4 workflows for dental practices in your inbox?

Every prompt on this page plus the rest, so you still have them on Monday. One email, then four short ones on making it stick. Unsubscribe any time.

Or answer four questions and Claude writes three workflows for your specific business rather than the industry generally.

Before you try it

More for dental practices

Full guide for dental practices