Letter of Appeal Template

If a previous authorization request has been denied, your patient may need a letter of appeal to get insurance coverage.


It’s easy to complete the letter

Just fill in the fields, and we'll generate a letter you can use instantly. You can preview it, then create a PDF to submit when enrolling your patient in NUPLAZIDconnect. You can also download the Letter of Appeal template. (All information required unless marked "optional")

Patient Gender
Patient has been diagnosed with Parkinson’s disease (PD)
In order to continue, you must correct the errors above.
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