To help parents prevent severe RSV disease 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 the parents have 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 patients with supportive information such as a
letter of medical necessity—if appropriate—that they may use
to appeal 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
independent non-profit organization that may be able to
provide support, at 1-866-316-7263.
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