SUSTENNA Sample Letter of Appeal for bb - Janssen CNS 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the date at the top of the letter. This is crucial for record-keeping and timely processing.
3. Fill in the recipient's details, including their name, title, and the health insurance company's address. Ensure accuracy to avoid delays.
4. In the 'Insured' section, input the patient's name, policy number, and group number. This information links your appeal directly to the patient’s account.
5. Clearly state the diagnosis along with its ICD-9-CM code. This helps substantiate your request for treatment coverage.
6. Craft a compelling introduction explaining why you are requesting benefits extension for INVEGA® SUSTENNA®. Include relevant treatment history and rationale.
7. Summarize the patient's medical history and prognosis in detail. This section should highlight previous treatments and responses to them.
8. Conclude with a polite request for extending benefits to include an injection center, providing your contact information for follow-up.

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