Q: What can I do if my insurance company denies coverage for RADICAVA ORS® or RADICAVA® IV?
Your insurance company may initially deny your treatment with RADICAVA ORS® or RADICAVA® IV. If this happens, you may be able to do something about it. Here are some ideas you may find helpful:
Talk to your doctor and call your health plan to request an exception for coverage of your medication
If you have been notified that your medication is not covered by your health plan or that you need to meet other requirements before obtaining it, you can call your health plan and request an exception for coverage of your medication.
Review this guide for some helpful steps you may follow: Requesting an Exception from Your Health Plan.
Talk to your doctor to see if it may be possible to file an appeal
If your request for an exception is denied you may be able to appeal the decision.
Having your doctor file an appeal may help give your insurance provider more details about why you should receive treatment.
If the appeal does not work, your doctor may request a next-level appeal. Some of the people that may be involved include a panel of doctors, an administrative judge, or a local state representative.
Consider other insurance plan options
If you or or your loved one has been diagnosed with ALS, there may be government health plan options to consider. Regardless of age, people diagnosed with ALS can apply for Social Security Disability Insurance (SSDI) benefits, and subsequently, can apply for Medicare and/or Medicaid coverage.
For questions about appeals or insurance coverage, call the JourneyMate Support Program™ Insurance & Access Specialist at 1-844-772-4548 to learn more.