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Coverage Denials Overturned

Getting the Help You Need to determine your insurance benefits

Since VNS Therapy was approved for TRD fairly recently, most insurance companies have not yet established their coverage policies. Case-by-case approvals have been obtained from more than 300 different payers over the past two years.

Several appeals steps may be required in order to gain coverage for VNS Therapy in TRD, and the process and number of steps vary from state to state and from plan to plan. In addition, if you have a self-funded employee benefit plan and your health plan denies coverage, your employer may be able to help you gain access to treatment. A Regional Case Manager can help you and your psychiatrist determine if your insurance covers VNS Therapy by verifying your benefits and determining the best way to pursue approval.

Please call your psychiatrist for additional information regarding how to go about the insurance benefits verification process or you may contact a Regional Case Manager at 1-877-NOW-4VNS (1-877-669-4867).

Additional resources are provided below for your convenience.

Resources:

Agencies and advocacy groups that may provide assistance during the appeals process:

1). Consumer Guide to Handling Disputes with Health Plans:
http://www.kff.org/consumerguide/7350.cfm

2). State’s Insurance Commissioner:
http://www.naic.org/state_web_map.htm

3). Attorneys General by State:
http://www.naag.org/ag/full_ag_table.php

State Legislators and U.S. Senator or House of Representative:

1). National Conference of State Legislators:
http://www.ncsl.org/public/leglinks.cfm

2). House of Representatives:
http://www.house.gov/

3). Senators:
http://www.senate.gov/general/contact_information/senators_cfm.cfm

4) State and Local NAMI's (National Alliance on Mental Illness)
 http://www.nami.org/Template.cfm?Section=Your_Local_NAMI&Template=/CustomSource/AffiliateFinder.cfm

 

   
 

 

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  UNITED STATES INDICATION FOR USE:
The VNS Therapy System is indicated for use as an adjunctive therapy in reducing the frequency of seizures in adults and adolescents over 12 years of age with partial onset seizures, which are refractory to antiepileptic medications.

VNS Therapy (or the VNS Therapy System) is indicated for the adjunctive long-term treatment of chronic or recurrent depression for patients over the age of 18 who are experiencing a major depressive episode and have not had an adequate response to four or more adequate antidepressant treatments.