Francis Medical has created example materials, including sample letters, for illustrative purposes only. Sample materials are available on request from the Francis Medical Reimbursement team. Providers are solely responsible for preparing and submitting prior authorization requests and/or appeals through the health plans process and ensuring that the information included accurately reflects the patient’s condition.

Additionally, patients through their provider can participate in a Francis Medical sponsored Patient Access Program through a third party, JDL Access. On behalf of the patient, and with the patient’s authorization, JDLA can provide support with the prior authorization process, including appeals, as necessary. Prior authorization and or predetermination are not guarantees of payment.