Patient's Insurance Not In Effect

Dr. Name
Office address
City, State ZIP
(or preferably print on letterhead)


Patient Name
Patient Address
City, State  Zip

Dear _____,

We recently received the enclosed Explanation of Benefits from the [insurance company].  As you can see, they denied coverage for your recent dental work because the policy was no longer in force.

If you have changed employers, or if your employer has changed insurance plans, please provide us with the current information. We will be happy to refile the claim.

If no insurance was in effect at the time of service, your prompt payment will be appreciated.



Jane Doe
Financial Coordinator for Dr. ______