For patients & families
Physician-led urology insurance appeals
A health-insurance denial may turn on the medical facts, the plan’s criteria, or the evidence for a treatment. Expert Urology Consulting evaluates that medical rationale and prepares medically supported appeals when the matter fits its expertise.
Led by Mark A. Wille, MD, FACS, a board-certified, clinically active urologist. Current service: Illinois commercial and employer-sponsored health plans.
Request a Case ScreeningEligibility · Process · Fees · Questions
What is a medical insurance appeal?
An appeal asks a health plan to reconsider a denial. An internal appeal is reviewed through the plan’s process; an external review, when available, is conducted by an independent reviewer. EUC can help explain the medical issues and prepare supporting materials within a defined engagement.
The work is physician-level medical analysis: comparing the documented care and relevant evidence with the reasons the plan gave for its decision.
Which denials may fit?
Urologic procedures and treatments
Clinically substantive denials involving kidney stone treatment, BPH (enlarged prostate) procedures, prostate or bladder cancer care, and other urologic treatment within Dr. Wille’s expertise.
Medications
Denials involving medical necessity, prior authorization or drug exceptions, when the medical record and evidence are central to the dispute. Understand medication denials and current Illinois plan rules.
Diagnostic testing and imaging
Review of the clinical rationale for denied urologic tests or imaging and the documentation needed to address the plan’s stated criteria.
Medical-necessity or investigational determinations
Disputes over whether care is medically necessary, experimental or investigational, including appropriate level-of-care issues and preparation for further review.
These are examples for screening, not a promise to accept every condition, procedure or medication.
Determine whether your case may qualify
The initial service is limited to Illinois patients with commercial or employer-sponsored health plans. The dispute should involve medical judgment, available urologic expertise and enough time for competent review.
Outside the current service: Medicare, Medicaid, workers’ compensation, disability benefits and property/casualty claims; routine billing or coding corrections, debt negotiation and primarily legal disputes. EUC does not provide treatment or prescribe medication through Patient Appeals.
Acceptance also depends on conflicts and availability. EUC will not work on opposite sides of the same or a substantially related dispute, or use confidential information from unrelated independent-review engagements.
From screening to engagement
- Submit screening information. Use the existing EUC Microsoft Forms questionnaire. Supply only the requested details; no full medical records.
- EUC reviews the request. The screen addresses scope, expertise, conflicts, deadlines and availability.
- Potentially suitable matters receive engagement materials. These include the agreement, fee schedule, representative appointment and records authorization, with separate document-return instructions.
- Physician review begins after engagement requirements are met. EUC confirms the written scope, signed documents, any required payment and necessary records.
- EUC prepares the agreed work. Filing an appeal or communicating on your behalf occurs only when specifically included and authorized.
Screening does not establish an engagement or extend a deadline. Until EUC confirms in writing that it is handling a specific submission, you remain responsible for following your denial notice and plan instructions.
What information will you need?
For screening, have your plan name and type, denied service, denial date, appeal deadline, treating clinician and any prior-review information available. The Microsoft Form also asks for identifying and contact information needed to screen the matter.
Keep the denial letter, relevant plan documents, medical records, treating-clinician support and previous appeal decisions for later review. Accepted clients receive separate upload instructions; do not send these documents through the general contact form or ordinary email.
Patient Appeals fees
| Service | Fee |
|---|---|
| Physician Denial Assessment | $295 |
| Standard Physician-Led Appeal | $895 |
| Complex Medical-Necessity Appeal | $1,495 |
| Experimental/Investigational + Literature Review | $1,995 |
| External Review Preparation | $750 |
| Expedited work | Additional fee when accepted |
Fees do not depend on the outcome. The $295 assessment is a separately scoped service; it does not automatically include an appeal, submission, representation or credit toward another service. External Review Preparation is EUC’s consulting fee, separate from any fee for the external-review process itself.
Illinois external-review guidance explains the difference between the official review process and paid preparation. Screening does not purchase a service. The applicable scope and fee are agreed before substantive work begins.
Common questions
How is screening different from the $295 assessment?
Screening checks eligibility, expertise, conflicts, availability and deadlines. It does not include a substantive medical-record review or a medical opinion on the denial. The Physician Denial Assessment is a separate paid service with an agreed scope. Appeal drafting, filing and follow-up are included only when specified in the engagement.
Can EUC guarantee that my denial will be reversed?
No. Physician review may identify support for an appeal, missing evidence or limitations in the case. The insurer or external reviewer decides coverage under the applicable process.
Does EUC replace my attorney or treating urologist?
No. Patient Appeals provides medical review and advocacy within an administrative appeal. It is not legal representation, legal advice or clinical treatment. Questions requiring legal analysis or litigation belong with independent counsel; care remains with your treating clinicians.
What if I already appealed?
EUC can screen an unresolved denial for medical issues that a prior submission may not have addressed. Further work depends on the available appeal route, remaining time, conflicts and a written scope.
How is confidential information handled?
The general website form is for nonconfidential inquiries. The separate Microsoft Forms questionnaire collects identifying, insurance and limited health-related details for screening. Full records are requested through separately provided transfer instructions after preliminary review and required authorization. Submit only what is requested; do not place medical details in public contact messages.
Can a caregiver or treating practice refer a patient?
Yes. Direct the patient or appropriate representative to the screening page. Helping with the form does not itself authorize record access or representation; the required authorizations are handled during engagement.
What if a deadline is close or care is urgent?
Contact your health plan and treating clinician promptly about the available urgent process. Do not wait for EUC screening to protect a deadline. EUC confirms expedited availability individually and does not monitor intake for emergencies.
Request review or use independent resources
If a paid physician review is not appropriate, your treating practice, plan and available consumer-assistance resources may help. See independent appeal resources and the guide to appeal stages.