Review your denial letter carefully. Identify the specific reason for the denial. This is crucial for building your appeal.
Gather Supporting Documentation
Collect medical records showing your diagnosis, treatment history, and the necessity of Cialis for your condition. Include any doctor’s notes specifically recommending Cialis. Obtain a letter from your doctor reiterating the medical necessity, addressing the reasons for denial if possible. This letter should clearly explain why Cialis is the best treatment option for you, based on your specific health situation. If you’ve tried alternative treatments unsuccessfully, document this as well.
File Your Appeal
Submit your appeal through the appropriate Tricare channel, following their exact instructions. This usually involves completing a specific form and including all your supporting documentation. Keep copies of everything you submit. Note the date of submission. Tricare generally provides a timeframe for their response; monitor this closely.
Follow Up
If you don’t hear back within the expected timeframe, contact Tricare directly to check the status of your appeal. Be polite but firm in your request for an update. Keep detailed records of all communication, including dates, times, and the names of individuals you speak with. If your appeal is denied again, understand your options for further recourse, such as appealing to a higher level within Tricare or seeking external assistance from a patient advocate or lawyer.
