SIR provides carrier advocacy letters to help you obtain prior authorization for your interventional radiology treatment or to appeal a denial of coverage.
The following are examples of a few common coverage request letters. The examples include letters for coverage for radiofrequency ablation of pulmonary tumor(s), MRI imaging of the uterus prior to uterine fibroid embolization, ovarian vein embolization for pelvic congestion syndrome, and prostatic artery embolization for benign prostatic hyperplasia. These templates include data, supporting evidence for the patient's needs, and can save you considerable work. Use these templates as guides when writing to carriers about certain treatments where reimbursement or a patient's coverage has been denied.
A sample template letter for unlisted codes: Unlisted CPT Code Template_v2.docx. For more sample template letters for other procedures, please see below.
Need help with your appeal?
SIR staff are available to assist you with crafting your letter to your insurance company to obtain coverage for your treatment. If a template does not yet exist for your treatment area, or you were denied coverage for your treatment, please fill out SIR's claim appeals form to submit your case to the team.
Submit your claiims denial
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