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Reimbursement resources
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Sample Letter of Medical Appeal
A letter with a customizable template for you to use if a health plan denies your patient access to SUSTOL.
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Sample Letter of Medical Necessity
A customizable letter your practice can use to provide health plans with a brief medical rationale for the use of SUSTOL.
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Product and program information


Heron Connect Reimbursement Support Reference Guide
Reference guide describing the Heron Connect Programs and Services.
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Heron Commitment Program® Flashcard
Highlights the coverage denial support provided to your practice through the Heron Commitment Program.
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Product Replacement Policy Flashcard
Highlights the product replacement policy offered to healthcare providers or direct purchasing customers through Heron Connect.
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Forms

Insurance Verification and Program Enrollment Form
One single form used to verify benefits and enroll patients in Heron Connect Programs.
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Practice Copay Assistance Program Enrollment Form
A one-time form your practice must complete in order to participate in the simplified Heron Connect Copay Assistance Program registration process.
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Patient Copay Assistance Program Registration Form
A form used to enroll individual patients solely into the Heron Connect Copay Assistance Program. The one-time Practice Copay Assistance Program Enrollment Form must also be completed.
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Heron Commitment Program® Enrollment Form
A form your practice must complete in order to be eligible for the Heron Commitment Program.
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Clinical materials and patient resource

Instructions for Use (IFU)
A document with information about the preparation and administration of SUSTOL® .
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Administration Tear Sheet
Illustrated overview and helpful hints to administer SUSTOL.