Keys to a Successful Appeal

The appeal process ensures that any critical decision that affects your care (such as whether you will receive neuromodulation or a bulking agent) is given the consideration it deserves. While the information on this website may be helpful to you, Uroplasty, Inc. cannot guarantee your success in gaining coverage. There are several factors that, when used together, give you the best chance to overturn a denial:

Step 1: Send a letter to the payer requesting that the coverage decision be reversed. Your letter should be written within the deadline mentioned in the denial notice, usually 1 - 4 weeks. It should contain relevant information about you, your condition, and the therapy. The following are sample letters for you to use. Please select the therapy and choose the reason of denial.

Step 2: Ask your doctor to send a second letter asking the payer to reconsider the decision to deny coverage. A second letter, written by your doctor, should contain supporting information that may not have been included in the first letter. This could include additional information about you, your condition, and neuromodulation or the bulking agent. Ask your doctor for a copy of the second letter to keep for your records. For faster results ask your doctor to call the payer.

Step 3: Be persistent. Follow-up with the doctor, medical office billing staff, and payer staff. The doctor's office staff is usually quite willing to help out (write letters, make calls, etc.) but you need to be in charge of the process.

Step 4: Write down each contact you make with your doctor, office staff and payer in a notebook. Note the date, contact person, and nature of your discussion. This will help you keep track of the details involved with your interactions.

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