APPEAL SECTION

This section is for women submitting an appeal letter to their insurance company.  The appeal letter outline is an EXAMPLE of information that might be helpful in the appeal process. 

"I want to thank N.B. of Michigan for volunteering the appeal information that follows (initials changed for confidentiality)." -  Hope 

The outline and letter are examples for the UAE procedure, but they can also be used for all the hysterectomy alternative procedures.

APPEAL LETTER OUTLINE 

Check your insurance company guidelines and receive prior approval for the UAE procedure as instructed.  Procedure codes may be needed (5 digit numbers). (If you have questions about this ask your Interventional Radiologist before starting any process.) 

When handling the Pre-Approval for UAE keep good records on any referral information.  Check identification insurance numbers on ALL forms to make sure the information is correct. 

Keep a record of ALL phone calls (date, time, person’s name, reason for calling). 

Make an effort to keep track of the approval process to make sure it has been pre-approved.  (It is unethical for an insurance company to inform a patient that a procedure is covered and then, after the procedure is completed, reverse the decision – On the other hand, all pre-approval letters will include a disclaimer saying that the pre-approval is not a guarantee of payment or coverage, which will require completion of the procedure and review of the paperwork.)

When checking the insurance company web site, print off all documentation that relates to your particular medical condition in case it is needed in the future.  Check the web site for uterine fibroids “Treatment for Symptoms” section to see if UFE or UAE is listed as an option for treatment.  “Blues” members can get information from personalpath.com.  

Standard Care for Treatment of Uterine Fibroids

The most legal definition of ‘standard of care’ is how similarly qualified practitioners would have managed patient’s care under the same or similar circumstances.  We believe that UAE is one of the ‘standards of care’ for treatment of uterine fibroids.  This can be evidenced by the fact that:  

Ø   A large number of insurance companies pay for this procedure. 

Ø   The Society Interventional Radiologist (SIR) have established standards for this procedure. 

Ø  There have been numerous studies published showing the safety and effectiveness of this procedure. 

Research the insurers who have paid for UAE (state and insurance company name required here). 

Research how many Interventional Radiologist perform the UAE in your state.  Check Society Interventional Radiologist (SIR) web site to see how many doctors are registered to perform UAE. 

The SIR has issued “Training Standards for Physicians Performing UAE for Leiomyomata and Reporting Standards for UAE for the treatment of Uterine Leiomyomata”. 

A description of the Uterine Artery Embolization medical procedure (with illustrations, if possible).   

In addition, magazine, newspapers, and web site articles reporting UAE as a widely accepted option for uterine fibroid treatment.  This will prove that UAE is not a new or untried procedure.

For a copy of the Research URL List contact  Hope.