Prior Authorization Request

Prior Authorization Request
Typically, your doctor makes the initial prior authorization request to your payer for neuromodulation or a bulking agent.

• He or she drafts a Letter of Medical Necessity describing the medical need and why they believe the neuromodulation or a bulking agent will benefit you.
• The payer reviews the letter and decides if they will or will not reimburse for the procedure.
• If they decide to cover the procedure, the payer will inform the doctor's office and the procedure is scheduled.

Tips
If the payer decides not to cover the procedure, you have the right to appeal that decision. In the initial authorization process, the role of the patient or family member is minimal. However, there are steps that can be taken to help the appeal process.

• Obtain the name and phone number of the staff person in the doctor's office who is assigned to coordinate and follow up with the prior authorization request made by the doctor on your behalf.
• Have a discussion with that person regarding the process and time expected to secure the prior authorization.
• Consider following up with that individual every one or two weeks regarding the status of your prior authorization request.

If you encounter a challenge on obtaining approval for your treatments, please contact the staff person at the physician’s office for assistance or ask them to contact the Uroplasty Reimbursement Solutions Group at 866-258-2182 for guidance in the prior authorization process.

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