For Physicians: How to Appeal a Denial on Behalf of a Patient

Purposes of the Appeal

  • Enables physician to discuss why the plan should cover the balloon dilation procedure for the specific patient’s case
  • Focuses on the benefits of the technology and its medical necessity based on the patient’s particular symptoms, diagnosis, and comorbidities through reference of peer review literature that supports your position

To learn more about this insurer’s policies, click the appropriate link below. For information on their policies concerning balloon sinus dilation, search for CPT code 31295, 31296, or 31297. For information on their appeal process, search "appeal process."