Template Letters

Many insurance companies (and employers) are unfamiliar with pulmonary hypertension, the complexity of treating this rare disorder and the notion that each patient needs individualized medical treatment.

This can create an extra obstacle for patients and delay access to treatment. However, medical professionals and patients can work together and use these template letters to expedite the process by educating insurance providers (and employers) on the correct course of action.

Employment Requests

• Short Term Disability or Return to Work Request

General Insurance Requests

• Request for In-Network Payment
• Physician Statement of Medical Necessity
• Appeal a Denied Claim
• Department of Insurance Complaint

Medicare Requests

• Appoint a Medicare Representative

PHA Advocacy Letters

• PH Treatment Access Letter
  After several state Medicaid programs removed PAH medications from their formularies, PHA's Scientific Leadership Council Insurance Committee wrote a letter explaining the importance of all PAH treatments being available for patients. If you encounter issues with access to your PAH treatment, include this letter along with a personalized letter from your PH specialist when you appeal or request an exemption.
• Combination Therapy Letter
  When BlueCross BlueShield (BCBS) of North Carolina eliminated coverage of combination therapy for oral PAH therapies, claiming that such coverage was “investigational” and therefore subject to denial, PHA’s Scientific Leadership Council and the Duke Pulmonary Hypertension Center teamed up to advocate against the policy. This letter helped convince BCBS of North Carolina to revoke their policy prohibiting coverage of PAH combination therapy.
  
  Contact 301-565-3004 x773 or Insurance@PHAssociation.org for more information.
  

Social Security Disability Requests

• Social Security Disability Insurance

Sildenafil (Revatio/Viagra) Requests

• Sildenafil Pre-authorization Request
• Sildenafil Approval
• Urgent Appeal for Sildenafil Coverage

Traveling Requests

• Flying with Medical Equipment
• Permission to Fly with Oxygen
• Permission to Cancel Flight

Share your letters with us! Help us expand this template letter collection by sending us your successful template letters. If there is a letter that has proved an effective tool in your role as patient advocate, share it with the PH community.