To help parents prevent severe RSV infection in high-risk
infants, it’s important to know whether their insurance covers
Synagis. Here are answers to some common questions your patients
may ask you.
Q. What can my patients do to find out whether they
are covered?A. While many health plans cover Synagis,
the levels of coverage and the requirements for getting it
can vary. Your patients can ask their employer and insurance
company if Synagis is covered, and how it would be
determined if their infant is eligible.
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Q. What if it's taking too long, or a patient's
coverage was denied?A. Incomplete insurance forms can
lead to delayed processing and denials. Make sure that your
patient has provided all of their baby's relevant medical
information. Any claims or reimbursement forms should be
checked to see if anything is missing or incorrect before
sending them.
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Q. There's a chance a patient might be denied
coverage. What else can they do?A. It may be helpful
to provide your patient with backup information. Studies on
RSV, risk factors, or a letter of medical necessity—if
appropriate—may help support your patient support their
case. Refer them to the MedImmune Hotline. You may also call the
Synagis Reimbursement Hotline at 1-877-480-8082.
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Q. Can a patient appeal a denial?A. If a
patient's insurance plan denies coverage or reimbursement
for Synagis, they may be able to appeal the decision. Their
best plan of action is working together with you and their
insurance company. Your office may be able to contact the
Synagis Reimbursement Hotline at 1-877-480-8082 to discuss
the appeals process.
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Q. What if a patient's insurance plan changes?A.
Your patient should inform your office immediately if their
insurance plan changes at any time. Many employers offer
open enrollment during October and November so employees can
make changes to their health plans. Patients enrolled in a
state Medicaid program also need to let your office know
before making any changes.
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Q. What if a patient doesn't have insurance,
Medicare, or Medicaid, and can’t get coverage for Synagis?A.
Eligible patients who can't get coverage can call the
MedImmune Assistance Program at 1-877-480-8082 and apply for assistance.
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Q. What if a patient needs help with a high co-pay
and deductible?A. Suggest that your patient contact
the Patient Access Network Foundation, an
indipendent non-profit organization that may be able to
provide support, at 1-866-316-7263.
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