Carrier Advocacy Request
The society has developed this form for members to submit carrier information when denied reimbursement to the physician or the patient for specific interventional radiology treatments.
To initiate societal “comment letters” please complete the information below.
Member Information
SIR Membership Number
Your SIR membership number can be found in your online member profile at https://www.sirweb.org/myaccount
First Name
Last Name
Email Address
Phone Number
Denial Information
Please complete as many of the fields as possible
Carrier
Denial Reason
State
Alternative Contact
Please provide an additional office contact who can answer questions regarding the denial.
Name
Email
Please attach a copy of the denial letter. All patient information must be redacted before submission
If you have any questions, please contact the
economics team
.