Getting a Test: Insurance Resource Center
Because Medtronic’s neurostimulation therapy has been used for more than 35 years and drug delivery therapy has been used for 18 years, most insurance companies and Medicare cover the therapies to treat chronic pain.
The process for obtaining coverage: Prior Authorization
If Medtronic Pain Therapies are allowed by your insurance plan, your doctor will submit a prior authorization request for your screening test. Your insurance company may have a medical policy with standard "Conditions of Coverage" that you must meet in order to be considered as a candidate for Medtronic pain therapies. Typically, there are three steps to the process:
- Your doctor drafts a Letter of Medical Necessity describing your chronic pain history and why they believe a Medtronic Pain Therapy is right for you.
- The insurance company reviews the letter, verifies that you meet their medical policy criteria, decides whether they will cover the therapy and notifies your doctor of the decision.
- Your doctor informs you of the insurance company's decision and schedules your screening test.
What to do if coverage is denied
It is possible that the insurance company will deny the prior authorization request. If your request is denied, you have the right to appeal by following these steps:
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Ask your doctor to call your insurance company or send another letter to communicate any additional information that may lead the insurance company to reconsider covering the therapy. Medtronic has resources to help your physician with this process at professional.medtronic.com/reimbursement.
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Write a letter to your insurance company requesting that they reverse the coverage decision. Include information about your condition and the therapy your doctor has recommended. You can use one of the following sample appeal letters depending on which therapy you are seeking and the insurance company's reason for denying the prior authorization request. Be sure to personalize this to tell your insurance company about your pain.
Neurostimulation
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Follow up with your doctor's office and the insurance company regularly to find out the status of the request. Keep track of all the letters and conversations. Be persistent.