Urgent® PC
Prior Authorization

MEDICARE
Prior authorization is not routinely required by Medicare.

PRIVATE PAYERS
Uroplasty recommends obtaining a prior authorization or pre-determination from the payer before a treatment. It is important to request approval for all 12 treatments at the outset to avoid confusion and potential denials of coverage. Uroplasty has developed tools that provide you with important reimbursement information. Click on the following flow chart to view a larger version.

PRIOR AUTHORIZATION APPEALS
The prior authorization or pre-determination request may be denied because the payer does not have enough information needed to make a favorable coverage decision. Potential reasons listed in the letter of denial may include:

• The therapy is investigational/experimental
• The therapy is not medically necessary

Tools are available to support you in the appeals process. To learn more, visit the Denials and Appeals page.