Cost of HCV Treatment
|
|
- Domenic Lyons
- 5 years ago
- Views:
Transcription
1 HCV: How Do We Get the Medications to Our Patients? Liver Institute of Virginia Bon Secours Health system Richmond, Richmond Virginia Liver Institute of Virginia Education, Research and Treatment IVer for Patients with Liver Disease Bon Secours Health System Cost of HCV Treatment O S Sofosbuvir-Ledipasvir f b i L di i (Harvoni) (H i) O ~$94,500 (12 weeks) O Ombitasvir, paritaprevir + ritonavir with dasabuvir (Viekira Pak) O ~$83,000 (12 weeks) 1
2 Cost of HCV Treatment O Peg-interferon O ~$10,000 (12 weeks) O Ribavirin O ~$900-$2700 (12 weeks) O ~$2700-$8100 (24 weeks) O Sofosbuvir (Sovaldi) O $1000/pill O $84,000-$168,000 (12 wks-24 weeks) O Simeprevir (Olysio) O $66,000 for 12 weeks of treatment Cost of HCV Treatment O Bristol-Myers B i t lm S Squibb ibb (d (daclatasvir l t i + sofosbuvir) August 2015 (genotype 3) O $??? O Merck (elbasvir/grazoprevir)- 1st quarter 2016 O Single tablet, once daily treatment O $??? 2
3 Getting Meds-Step 1 O Make M k sure patients ti t h have h had d allll required i d blood tests and procedures O Blood work O Liver biopsy/fibroscan O EGD and abdominal ultrasound completed if patient is cirrhotic Getting Meds-Step 2 O Submit S b it iinformation f ti tto your dedicated d di t d specialty pharmacy. This should include: O Current insurance card O Recent lab results including HCV RNA and HCV genotype O Fibrosis score results O Most recent office note O Prescriptions for all medications 3
4 Getting Meds-Step 3 O Keep K a folder/file f ld /fil for f each h patient ti t O Prior authorization is usually needed for some or all medications O PA forms or PA phone number will be provided by the specialty pharmacy O Approval is quicker over the phone if you have time to answer questions O Call insurance company first thing in the morning (shorter hold time) What is Prior Authorization? O Noun N {prah-yer { h aw-ther-uh-zey-shuh th h h h n}} 1. Voluminous paperwork that turns relatively simple, all oral regimens into an administrative nightmare 2. An obstacle created to discourage providers from treating patients with HCV 4
5 What is Prior Authorization? (cont.) O 3. 3 A system t that th t frequently f tl removes treatment decisions from the provider/patient and places it within the realm of an anonymous voice at the other end of the telephone O See: Appeals Process O Also Al see: T Twilight ili ht Z Zone Courtesy: Michael Fried, MD Getting Meds-Step 4 O If medications are approved, approved a letter of approval will be sent to your office via fax O Fax letter of approval with prescriptions to specialty pharmacy (mandated or preferred) O Call patient to give update regarding approval O Make an appointment for teaching if needed 5
6 Getting Meds-Step 5 O If patients ti t are initially i iti ll d deniedi d O Develop a form letter for each common patient situation to use for appeals O Support staff can personalize it for each patient and providers can review, sign it and send it off with clinical information and supporting data O Too much information is better than too little O Include AASLD/IDSA recommendations Common Reasons for Denials O Many insurance carriers now restrict treatment to only patients with F3-F4 fibrosis scores O Medicaid now requires regular drug testing (at least 3 over a 3 month period) and documentation of negative results O Insurance carriers may have a preferred regimen on formulary 6
7 Patient Example O 75 y.o. Caucasian C i ffemale l O Liver transplant recipient in June 2010 O Mild renal insufficiency (creatinine ~1.5) O HCV RNA 4.5 mil IU/mL O Genotype 1a O All other labs are stable O Fibrosis score in 2012: F1 Patient Example (cont.) O Submitted S b itt d prescription i ti for f ledipasvir/sofosbuvir x 24 weeks O Insurance approved 8 weeks of therapy due to mild liver disease and HCV RNA <6 mil O A letter was written to her insurance explaining patient s case and rationale for longer therapy O Patient was approved for 24 weeks 7
8 Fight For Your Patients! O Special S i l populations l ti should h ld ggett an exception ti for treatment O Cryoglobulinemia (even with mild liver disease) O Liver transplant recipients should be approved for longer therapy (not 8 weeks!) O Patients with previous decompensated liver disease that subsequently stabilized and can now tolerate treatment Know Criteria for Common Insurance Companies O Familiarize F ili i yourself lf with ith th the criteria it i th thatt common insurance companies require to get patients approved. For example: O Drug testing O Labs performed in a certain time frame O Fibrosis score O HCV genotype and viral load 8
9 Know Criteria for Common Insurance Companies Know Criteria for Common Insurance Companies 9
10 Know Criteria for Common Insurance Companies Support Staff O Have H enough h supportt staff t ff to t assist i t with ith PAs PA and patient/provider needs O An alternate option is to use your dedicated smaller specialty pharmacy to help O Take time to train nurses and/or medical assistants about HCV including genotypes, viral i l lloads, d fib fibrosis i score, and d other th llab b values to assist with insurance and pharmacy calls 10
11 Stay Organized O EMR EMR-now now very common O Paper records for HCV treatment will be more helpful to stay organized O Patient packets O Keep a file for each patient. This should include: O Prescription referral O Insurance information O Recent labs ((including g ggenotype yp and viral load)) O PA paperwork with approval/denial documentation O Keep track of prior authorization expiration dates Delivery of Medication O Depending on the patient: O Medications will usually be mailed directly to patient s home O Medications can be mailed to the provider s office if there is a concern regarding patient s understanding of treatment O Closer monitoring of patient- they have to make each follow up appointment to get medication O Storage of meds can be an issue (refrigeration, locked med room) 11
12 The Long and Winding Road to Treating a Patient with HCV Office staff completes Specific Prior Authorization Request Provider discusses treatment with patient and writes prescription FAX Form to Pharmacy Benefits Manager Wait Need More Info : ReFAX Denied Call to find out what happened: on hold min Approved Courtesy of Michael Fried, MD Take Home Points O Train T i and d use your supportt staff t ff O Accept help from a small specialty pharmacy O Organization is key O Keep a packet for each patient until they complete treatment O Know the approval criteria for common insurance companies in your area 12
13 13
From Prescription to Patient: Navigating Barriers to HCV Treatment Initiation. Autumn Bagwell, PharmD, BCPS, AAHIVP Vanderbilt Specialty Pharmacy
From Prescription to Patient: Navigating Barriers to HCV Treatment Initiation Autumn Bagwell, PharmD, BCPS, AAHIVP Vanderbilt Specialty Pharmacy Objectives At the end of this presentation, the learner
More informationPrior Authorization, Pharmacy and Health Case Management Information. Prior Authorization. Pharmacy Information. Health Case Management
Prior Authorization, Pharmacy and Health Case Management Information The purpose of this information sheet is to provide you with details on how Great-West Life will be assessing and managing your claim
More informationPrior Authorization, Pharmacy and Health Case Management Information. Prior Authorization. Pharmacy Information. Health Case Management
This document contains both information and form fields. To read information, use the Down Arrow from a form field. Prior Authorization, Pharmacy and Health Case Management Information The purpose of this
More informationPharmacy program overview. Amerigroup Community Care
Pharmacy program overview Amerigroup Community Care WEBPMD-0100-17 November 2017 Pharmacy benefit objectives The pharmacy benefit is designed to ensure the efficient, safe provision of prescription services
More informationINTERNATIONAL TRENDS SERIES
INTERNATIONAL TRENDS SERIES Issue 5: Private Payer Exclusivity Agreements June 8, 2015 Copyright 2015 by PDCI Market Access Inc. The information presented is property of PDCI Market Access. Unauthorized
More informationOVERVIEW PROCESS SERVICES HARVONI. Simply on Your Side. Please see full Prescribing Information, including Patient Information.
HARVONI Simply on Your Side. OVERVIEW PROCESS SERVICES A breakthrough treatment with exceptional support Living with hepatitis C (Hep C) can come with a lot of uncertainty. But getting started with Hep
More informationPatient Welcome Form!
Arthritis and Rheumatology Clinical Center of Northern Virginia, PLLC 8130 Boone Blvd suite 340 Vienna VA 22182 Mahsa Tehrani MD 703-734-2222 Mahnaz Momeni MD Patient Welcome Form Dear new patient, Welcome
More informationUnderstanding Your Healthcare Benefits. A Patient s Guide
A Patient s Guide Understanding Your Healthcare Benefits This guide provides useful information about how health insurance assists with paying for treatments TABLE OF CONTENTS 2 What Is Health Insurance?
More informationCARECOUNSEL TIPS SELECTING A HEALTH PLAN. Step 1: Gather Basic Information. Step 2: Assess Your Needs
SELECTING A HEALTH PLAN Choosing between health plans is no longer a simple matter. As a healthcare consumer, it s important that you educate yourself about the various health plans available to you. You
More informationGilead Sciences Announces Fourth Quarter and Full Year 2014 Financial Results
Gilead Sciences Announces Fourth Quarter and Full Year 2014 Financial Results February 3, 2015 4:07 PM ET - Fourth Quarter Product Sales of $7.2 billion, Up 137 percent Year over Year - - Full Year 2014
More informationChallenges in High Dollar Drugs. Suzanne Francart, PharmD, BCPS Manager Infusion Services & Medication Assistance Program UNC HealthCare
Challenges in High Dollar Drugs Suzanne Francart, PharmD, BCPS Manager Infusion Services & Medication Assistance Program UNC HealthCare Disclosure I have no relevant conflicts of interest to disclose Learning
More informationChapter 17: Pharmacy and Drug Formulary
Chapter 17: Pharmacy and Drug Formulary Introduction Health Choice Insurance Co. (Health Choice) is pleased to provide the Health Choice Formulary, which is available on line at www.healthchoiceessential.com/members/rxdrugs.
More informationSimple Facts About Medicare
Simple Facts About Medicare What is Medicare? Medicare is a federal system of health insurance for people over 65 years of age and for certain younger people with disabilities. There are two types of Medicare:
More information2017 Plan Analysis for Qualified Health Plans: PENNSYLVANIA. Produced in collaboration with the AIDS Law Project of Pennsylvania
2017 Plan Analysis for Qualified Health Plans: PENNSYLVANIA Produced in collaboration with the AIDS Law Project of Pennsylvania Table of Contents: Introduction...1 Overview...3 How to Use This Tool...5
More informationIntroduction to UnitedHealthcare Community Plan of California/Medi-Cal
Introduction to UnitedHealthcare Community Plan of California/Medi-Cal Welcome/Agenda: Mission/Vision UnitedHealthcare Community Plan of California/Medi-Cal Member Eligibility and Benefits Notification
More informationSection Eleven. Referrals and Prior Authorization REFERRAL PROCESS. Physician Referrals within Plan Network
REFERRAL PROCESS Physician Referrals within Plan Network Physicians may refer members to any Specialty Care Physician (Specialist) or ancillary provider within the Fidelis Care network. Except as noted
More informationMedications can be a large
Find tips for talking about healthcare costs and the appeal process inside. Common Roadblocks to Care Advice to prevent and deal with the most common insurance-related hurdles The Doctor I Need Is Out
More informationHOW TO MAKE A COMPLAINT, REQUEST A COVERAGE DECISION,
OPTIMA MEDICARE HMO HOW TO MAKE A COMPLAINT, REQUEST A COVERAGE DECISION, OR FILE AN APPEAL ABOUT COVERED MEDICARE PART C MEDICAL CARE AND SERVICES OR COVERED PART D PRESCRIPTION DRUGS Optima Medicare
More informationGlossary of Terms. Adjudication: The way a health plan decides how much it will pay for certain expenses.
Page 1 Glossary of Terms Adjudication: The way a health plan decides how much it will pay for certain expenses. Affordable Care Act (ACA): The comprehensive health care reform law enacted in March 2010.
More informationStandard Gold Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
Massachusetts Standard Gold Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018 12/31/2018 Coverage for: Individual + Family Plan Type:
More informationStandard Bronze Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
Massachusetts Standard Bronze Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018 12/31/2018 Coverage for: Individual + Family Plan Type:
More informationThe Harvard Pilgrim Best Buy HMO Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
Massachusetts The Harvard Pilgrim Best Buy HMO Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 12/01/2017 11/30/2018 Coverage for: Individual
More informationBest Buy HMO FLEX Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
Massachusetts Best Buy HMO 2000 - FLEX Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018 03/31/2018 Coverage for: Individual + Family
More informationBest Buy HMO FLEX Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
Massachusetts Best Buy HMO 500 - FLEX Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 04/01/2018 03/31/2019 Coverage for: Individual + Family
More informationBest Buy HSA HMO FLEX Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
Massachusetts Best Buy HSA HMO 3100 - FLEX Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018 03/31/2018 Coverage for: Individual +
More informationBest Buy HSA HMO FLEX Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
Massachusetts Best Buy HSA HMO 2000 - FLEX Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018 03/31/2018 Coverage for: Individual +
More informationHMO - FLEX Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
Massachusetts HMO - FLEX Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019 12/31/2019 Coverage for: Individual + Family Plan Type:
More informationChapter 6: Medical Authorizations and Referrals
Chapter 6: Medical Authorizations and Referrals Overview Health Choice Insurance Co. has confidence that Primary Care Physicians are capable of providing the majority of medically necessary healthcare
More informationThe Harvard Pilgrim PPO Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
Massachusetts The Harvard Pilgrim PPO Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 12/01/2017 11/30/2018 Coverage for: Individual + Family
More informationMaine's Choice HSA HMO 5000 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
Maine Maine's Choice HSA HMO 5000 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018 12/31/2018 Coverage for: Individual + Family Plan
More informationFAX completed and signed enrollment form to BMS Access Support at
Simple Steps to Enroll Physician Complete the Services, Treatment, and Site of Care (if applicable) Sections on page 1 Complete the Physician Information section on page 2 Read, sign, and date the Physician
More informationthis plan begins to pay. If you have other family members on the plan each family member deductible?
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: Beginning On or After 1/1/2018 Platinum 90 PPO Coverage for: Individual + Family Plan Type:
More informationPatient Information. Financial Handbook For Liver Transplant Patients
Patient Information Financial Handbook For Liver Transplant Patients Beaumont Transplant Clinic Directory Beaumont Hospital, Royal Oak Medical Office Building 3535 West 13 Mile Road, Suite 644 Royal Oak,
More informationSummary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: Beginning On or After 1/1/2018 Gold 80 HMO Trio Coverage for: Individual + Family Plan Type:
More informationElevateHealth Gold 1000 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
New Hampshire ElevateHealth Gold 1000 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018 12/31/2018 Coverage for: Individual + Family
More informationVertex Reports First Quarter 2013 Financial Results and Reviews Recent Progress in Development Programs for Cystic Fibrosis and Hepatitis C
April 30, 2013 Vertex Reports First Quarter 2013 Financial Results and Reviews Recent Progress in Development Programs for Cystic Fibrosis and Hepatitis C -First quarter 2013 total revenues of $328 million,
More informationPOS Plans. Administered by Optima Health Plan BENEFIT INFORMATION GUIDE
POS Plans Administered by Optima Health Plan BENEFIT INFORMATION GUIDE v7.2016 If you are considering Optima Health or are new to the plan and do not have a member ID card, please call us toll-free at
More informationYOUR DRUG(S) IS NOT ON OUR LIST OF COVERED DRUGS (FORMULARY) OR IS SUBJECT TO CERTAIN LIMITS
Aetna Better Health of Virginia (HMO SNP) 9881 Mayland Drive Richmond, VA 23233 YOUR DRUG(S) IS NOT ON OUR LIST OF COVERED DRUGS (FORMULARY) OR IS SUBJECT
More informationPRESCRIPTION DRUG EXPENSE BENEFIT 2019
PRESCRIPTION DRUG EXPENSE BENEFIT 2019 Welcome to the Prescription Drug benefit, administered by Express Scripts, Inc. (ESI). To receive the highest level of benefits, prescription drugs must be obtained
More informationAnnual Notice of Changes for 2019
VIVA MEDICARE Me (HMO) offered by VIVA HEALTH, Inc. Annual Notice of Changes for 2019 You are currently enrolled as a member of VIVA MEDICARE Me. Next year, there will be some changes to the plan s costs
More informationSummary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/ /31/2019
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019 12/31/2019 Highmark West Virginia: my Blue Access WV EPO Silver 4450 HSA Coverage
More information21 - Pharmacy Services
21 - Pharmacy Services The role of Health Plan of Nevada s (HPN) Pharmacy Services is to evaluate and determine the appropriateness of quality drug therapy while maintaining and improving therapeutic outcomes.
More informationAnnual Notice of Changes for 2018
VIVA MEDICARE Me (HMO) offered by VIVA HEALTH, INC. Annual Notice of Changes for 2018 You are currently enrolled as a member of VIVA MEDICARE Me. Next year, there will be some changes to the plan s costs
More informationCost Considerations for PrEP Access
Cost Considerations for PrEP Access Laura Beauchamps, MD UMMC, Assistant Professor Infectious Disease Medical Director, Open Arms Healthcare Center April 15, 2016 Continuing Medical Education Disclosure
More informationSummary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/ /31/2019
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019 12/31/2019 Highmark West Virginia: my Blue Access WV EPO Bronze 4000 Coverage for:
More informationmaterial modifications
summary of material modifications Important Benefits Information The SBC Umbrella Benefit Plan No. 1 This summary of material modifications (SMM) is an update to the SBC Umbrella Benefit Plan No. 1 (Plan)
More information$200 individual/$400 family combined network and out-of-network.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019-12/31/2019 New Castle County Government : Blue Choice PPO Coverage for: Individual/Family
More informationKaiser Family Foundation, Assessing Americans Familiarity with Health Insurance Terms and Concepts Appendix Tables
Kaiser Family Foundation, Assessing Americans Familiarity with Health Insurance Terms and Concepts Appendix Tables Total Insurance Status Age Gender Education Level Insured (age 18-64) Uninsured (age 18-64)
More informationMED SUPP 2018 PROD BRO Alliance Medicare Supplement Brochure
MED SUPP 2018 PROD BRO 2018 Supplement Brochure Supplement helps f ill the gaps in Original. With Original, you are covered for many hospital and medical expenses, but there are some gaps in that coverage
More informationMemberChoice FORMULARY MANAGEMENT MEDICATION THERAPY MANAGEMENT (MTM) SPECIALTY DRUG MANAGEMENT. Specialty Drug Management
MemberChoice FORMULARY MANAGEMENT MEDICATION THERAPY MANAGEMENT (MTM) SPECIALTY DRUG MANAGEMENT SPECIALTY DRUG MANAGEMENT 1 1% Prescriptions Written in 2012 99% 25% Prescription Drug Spending in 2012 75%
More informationGilead Sciences Announces Fourth Quarter and Full Year 2013 Financial Results
Gilead Sciences Announces Fourth Quarter and Full Year 2013 Financial Results February 4, 2014 4:06 PM ET - Fourth Quarter Product Sales of $3.04 billion, Up 21 percent Year over Year - - Full Year 2013
More informationMedication Limitation of Non Coverage for Prevention Benefit Coverage with Waived Cost Share
Cost Share Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy Coverage Guideline must be
More informationCHILDREN'S SPECIAL HEALTH CARE SERVICES
CHILDREN'S SPECIAL HEALTH CARE SERVICES Indiana State Department of Health 2 North Meridian Street Section 7-B Indianapolis, IN 46204 (800) 475-1355 (In-State only) (317) 233-1382 Fax (317) 233-1342 August
More informationSummary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/ /31/2019
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019 12/31/2019 Highmark West Virginia: my Blue Access WV EPO Silver 3500-2 Free PCP Visits
More informationUnderstanding Insurance Options for Patients With Spinal Muscular Atrophy
Understanding Insurance for Patients With Spinal Muscular Atrophy USING THIS GUIDE Facing a diagnosis of spinal muscular atrophy (SMA) for you or your child can feel overwhelming. No matter where you are
More informationCoverage for: Individual + Family Plan Type: PPO
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 09/01/2018-12/31/2018 Venezia Transport Service: High Plan Coverage for: Individual + Family
More informationTHE MEDICARE R x DRUG LAW
THE MEDICARE R x DRUG LAW The Exceptions and Appeals Process: Issues and Concerns in Obtaining Coverage Under the Medicare Part D Prescription Drug Benefit Prepared by Vicki Gottlich, Esq. Center for Medicare
More informationPatient Resource Guide
Access Services Patient Resource Guide AstraZeneca Access 360 is committed to helping you access our medicines. This guide will provide you with information and resources to help you understand how to
More informationFinancial Planning. Patient Education. For a liver transplant
Patient Education Financial Planning For a liver transplant Liver transplants are expensive. Planning your finances, both your income and insurance, will be a key part of planning for transplant. The planning
More informationSummary of Benefits and Coverage:
Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 07/01/2018-06/30/2019 Allegheny County Schools Health Insurance Consortium: Community Blue Flex Coverage for: Individual/Family
More informationSummary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/ /31/2018
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018-12/31/2018 Pennsylvania Turnpike Commission: Highmark PPO Blue Coverage for: Individual/Family
More informationYou don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019-12/31/2019 Highmark Blue Shield: PPO Blue Coverage for: Individual/Family Plan Type:
More informationSummary of Benefits and Coverage: What This Plan Covers & What You Pay For Covered Services Coverage Period: Beginning On or After 01/01/2018
Summary of Benefits and Coverage: What This Plan Covers & What You Pay For Covered Services Coverage Period: Beginning On or After 01/01/2018 California Association of Professional Employees Custom POS
More informationYou don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019-12/31/2019 Highmark Blue Cross Blue Shield: BlueCare HMO Coverage for: Individual/Family
More informationCoverage Determinations, Appeals and Grievances
Coverage Determinations, Appeals and Grievances Filing a grievance (making a complaint) about your prescription coverage Asking for a coverage determination (coverage decision) 60-day formulary change
More informationCoverage Period: 01/01/ /31/2019 Gold Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
BlueCare 1865 Coverage Period: 01/01/2019-12/31/2019 Gold Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage for: Individual and/or Family Plan Type: HMO
More informationWhat is the overall deductible? See the Common Medical Events chart below for your costs for services this plan covers.
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about
More informationCoverage for: Individual/Family Plan Type: PPO
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about
More informationCoverage Period: 01/01/ /31/2019 Gold Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
BlueCare 1565 Coverage Period: 01/01/2019-12/31/2019 Gold Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage for: Individual and/or Family Plan Type: HMO
More informationCoverage for: Individual/Family Plan Type: PPO
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about
More informationCoverage for: Individual/Family Plan Type: PPO
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about
More informationCoverage Period: 01/01/ /31/2019 Bronze Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
myblue 1711S Coverage Period: 01/01/2019-12/31/2019 Bronze Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage for: Individual and/or Family Plan Type:
More informationKroll Ontrack, LLC Prescription Drug Plan. Plan Document and Summary Plan Description
Kroll Ontrack, LLC Prescription Drug Plan Plan Document and Summary Plan Description Effective December 9, 2016 Kroll Ontrack, LLC reserves the right to amend the Kroll Ontrack, LLC Health & Welfare Plan
More informationCoverage for: Individual/Family Plan Type: PPO
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about
More informationYou don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018-12/31/2018 Highmark Health Insurance Company: my Direct Blue Major Events EPO 7350
More informationAppeals Provider Manual - New Jersey 15
Table of Contents Medical Necessity appeals... 15.1 Member or provider on behalf of Member appeals process... 15.1 Internal utilization management appeals... 15.1 Stage I appeals (internal)... 15.3 Nonexpedited
More informationBlueSelect In-Network: $6,200 Per Person/$12,400 Family. Out-of- Network: $12,400 Per Person/$24,800 Family.
BlueSelect 1449 Coverage Period: 01/01/2019-12/31/2019 Bronze Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage for: Individual and/or Family Plan Type:
More informationCoverage for: Individual/Family Plan Type: PPO
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about
More informationWhat is the overall deductible? $3,000/Individual, $6,000/Family per benefit period.
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about
More informationSummary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services. Coverage Period: 7/1/2017 to 6/30/2018
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 7/1/2017 to 6/30/2018 Long Beach Unified School District 1500/3000 Coverage for: Individual
More informationCoverage for: Individual + Family Plan Type: PPO
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019-12/31/2019 Chestnut Hill College: PPO 2 Coverage for: Individual + Family Plan Type:
More informationSummary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 1/1/19 12/31/19
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 1/1/19 12/31/19 Toledo Electrical Welfare Fund : Plan M Medicare Supplement Coverage for: Individual/Family
More informationCoverage for: Individual/Family Plan Type: PPO
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about
More informationBlueSelect What is the overall deductible? In-Network: Not Applicable. Outof-Network: $500 Per Person.
BlueSelect 1535 Coverage Period: 01/01/2019-12/31/2019 Gold Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage for: Individual and/or Family Plan Type:
More informationYou don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019-12/31/2019 Highmark Blue Cross Blue Shield: BlueCare Custom PPO Coverage for: Individual/Family
More informationYou don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018-12/31/2018 Highmark Blue Cross Blue Shield: Major Events Blue PPO 7350 a Community
More informationCoverage for: Individual/Family Plan Type: PPO
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about
More informationWhat is the overall deductible? $3,000/Individual, $6,000/Family per benefit period.
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about
More informationCoverage for: Individual/Family Plan Type: PPO
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about
More informationCoverage for: Single Enrollee Plan Type: TRAD/PPO. Important Questions Answers Why This Matters: $2,500/single Network $5,000/single Non-Network
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018-12/31/2018 STRS OHIO : Basic Plan with Medicare Part B Only Coverage for: Single
More informationSummary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: Beginning on or after 1/1/2019
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: Beginning on or after 1/1/2019 Kalamazoo College, G-1013: Orange Plan Coverage for: Covered
More information01/01/ /31/2018 FLORIDA SCHOOLS HEALTH INSURANCE PROG:
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018 12/31/2018 FLORIDA SCHOOLS HEALTH INSURANCE PROG: 7670-00-410536 010 020 Coverage
More information2019 Alliance Medicare Supplement Brochure
2019 Supplement Brochure MED SUPP 2019 PRODUCT BROCHURE Find the right plan for you. Supplement offers a choice of plans Plan A, Plan C, Plan F, Plan G and Plan N. The benefits of each of these plans are
More informationUsing Your Medicare Drug Plan: What to Do if Your Medicine Isn t Covered SPRING 2007
Using Your Medicare Drug Plan: What to Do if Your Medicine Isn t Covered SPRING 2007 www.yourpharmacybenefit.org Table of Contents How does it work?............................................ 1 When should
More informationINFORMATION ABOUT MEDICARE A GUIDE FOR PEOPLE WITH RELAPSING MULTIPLE SCLEROSIS
INFORMATION ABOUT MEDICARE A GUIDE FOR PEOPLE WITH RELAPSING MULTIPLE SCLEROSIS HOW TO CHOOSE A MEDICARE PLAN If you are living with relapsing multiple sclerosis (RMS), you have a lot to think about. One
More information$1,500 individual/$3,000 family network. $3,000 individual/$6,000 family out-ofnetwork.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018-12/31/2018 Journey Health Systems: PPO Coverage for: Individual/Family Plan Type:
More informationREQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax:
REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax: Address: Fax Number: Aetna Better Health of Virginia (HMO SNP) 1-877-270-0148 Part D Coverage Determination
More information2018 Summary of Benefits
January 1 December 31, 2018 2018 Summary of Benefits Kaiser Permanente Medicare Advantage (HMO) for Federal Members High, Standard, and High Deductible Health Plan Options MA0001579-51-17 About this Summary
More informationSummary of Benefits. Albemarle Choice HDHP-HSA. (Plan uses KeyCare PPO. providers)
Summary of Benefits Albemarle Choice HDHP-HSA (Plan uses KeyCare PPO providers) Effective October 1, 2018-December 31, 2019 Lumenos HSA-HDHP 478 Albemarle Choice plan 10/1/18-12/31/19 In-Network Services
More informationYou don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018-12/31/2018 Highmark Blue Cross Blue Shield: my Direct Blue Conemaugh EPO 6950B Coverage
More information