Do This If Your Health Insurance Denies Access To Life Saving Epinephrine
Epinephrine is the only medication that can reverse the symptoms of anaphylaxis. We firmly believe that ALL individuals with food allergies should have affordable access to life-saving epinephrine. When an insurer does not provide affordable access to epinephrine, you can initiate an appeals process through your insurance carrier.
Here are some tips to help you get through the appeals process:
👉 Record all interactions with your insurer, including names of employees you speak to and the dates you speak to them.
👉 Save all copies of claims, bills, appeal letters, emails, and other relevant communications.
👉 Pursue your appeal.
👉 If your appeal is denied, go to the next level of appeal.
👉 Since this is not automatic, make sure you request a second-level, or external review.
👉 If the external reviewers think your plan should cover your claim, your health plan should cover it.
👉 Start by reviewing your insurance plan documents.
👉 Review the official response to your claim.
👉 Understand why the prescription was denied or why more of the cost was not covered.
👉 Look for errors in the billing code, patient ID number, date of service, or other information.
👉 If all of the information is correct, your next step is to prepare for your appeal.
👉 Write a clear and concise letter. Provide a simple explanation of why you believe the prescription should be covered. You can ask your doctor's office for help.
👉 Include your insurance ID number, claim number, date of claim, and the contact info of the provider who wrote the prescription.
SOME ADDITIONAL TIPS:
👉 If your insurance requires you to get prescriptions by mail for a reduced price, make sure that the auto-injector will be protected from extreme temperatures.
👉 If you have a children’s hospital nearby, find out what support or grants it may provide to help you pay for the prescription.
👉 Consider changing your health insurance plan.
👉 Check pricing with different pharmacies in your area.
