Other Resources to Assist in the Appeal Process

f you find that you are unable to overturn an appeal, the following are additional resources that may be of assistance.

1. External Review Process: Medicare and many other payers have contracts with independent companies to resolve disputes. You may find additional information on the Medicare appeal process at www.medicareappeal.com.
   
   If the patient has commercial insurance (not Medicare), the initial denial is not automatically forwarded to a dispute resolution company. If a dispute resolution service is available, either you or the patient can request a review. Contact the payer for more information on their external review process/service.
2. Employer Group Assistance: Employers who provide benefits to their employees through non-Medicare payers can often request that "an exception to benefits" be made that allows coverage for neuromodulation or a bulking agent. The patient’s employer's Human Resources Department should be able to provide benefit information and contacts.
3. Insurance Commissioner: Contact the insurance commissioner in your state to discuss possible ways to pursue coverage and payment through the payer. You can find an updated list of insurance commissioners at www.naic.org.
4. Attorney General: Contact the state attorney general for assistance with an appeal process. A formal health care complaint must be submitted within a certain time period. A current list of state attorney generals can be found at www.naag.org.
5. The Uroplasty Reimbursement Group:  One of Uroplasty’s Case Managers can provide guidance on state specific insurance coverage, prior authorization and/or appeal process. Contact the Uroplasty Reimbursement Group by calling 866-258-2182.
   

    

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