How can I determine if my insurance covers VNS Therapy?
To have your insurance benefits verified for VNS Therapy, you can either speak with a nurse case manager by calling 1-877-NOW-4VNS (1-877-669-4867) or complete an Insurance Verification and Patient Education Authorization form, known as an IVEA. The IVEA form is HIPAA compliant (protects patient privacy) and provides a nurse case manager with your insurance information to facilitate insurance benefits verification. The IVEA form can be downloaded by clicking here, completed and then faxed to (888) 577-7205. Once your IVEA Form is received, a nurse case manager will contact you to discuss your insurance benefits.

After I submit the IVEA, what are my next steps?
After you submit the IVEA, a nurse case manager will contact you to discuss your insurance benefits. Then, a Verification Specialist will contact your insurance company to verify your insurance benefits and determine next steps with your specific insurance company. Frequently, a prior authorization is the next step in the process. If a prior authorization is necessary, your nurse case manager will contact your psychiatrist to obtain your medical history for the last couple of years and your psychiatrist may need to submit a letter of medical necessity. Then, this medical history and letter will be submitted to your insurance company to obtain authorization for VNS Therapy.

What does prior authorization mean?
In many instances, your insurer must authorize coverage of VNS Therapy before you can receive VNS Therapy. Your Insurance company may need to review your medical history in order to agree with your psychiatrist that VNS Therapy is medically necessary for you. Once they agree, you have approval before the procedure is done and are free to go forward. When a prior authorization is required, a nurse case manager can collect your clinical information from your psychiatrist and submit the necessary information to your insurer for you.

What is the average length of time it takes to obtain a decision in the prior authorization process?
It can vary from 2 weeks to 6 weeks. The average expected length of time for a decision depends on whether a formal review is required, if additional treatments are required, and/or if a second opinion is required prior to a decision.

If an insurer denies VNS Therapy, what are the next steps?

• The Cyberonics Case Management Department is able and willing to assist in the appeal process.
• Request information regarding appeal process.
• Begin the appeal process by submitting an appeal letter from your psychiatrist to the insurance company that includes additional information. Additional resources are available to assist your psychiatrist in writing the appeal letter on this website in the healthcare professionals section of TRD Insurance Coverage and Reimbursement.
• If it is apparent that the payer has a lack of understanding regarding VNS Therapy, a Cyberonics reimbursement specialist can work with your case manager to provide an educational program for the insurer.