4 Questions to Ask About Infusion Therapy Insurance Coverage

Infusion therapy is often an expensive treatment approach, and it is important to understand your infusion therapy insurance coverage and what questions to ask when you talk to your insurance company.

If your provider prescribes infusion therapy to treat your condition, here are some recommended questions to ask about insurance coverage.

What, if any, medications must be tried before infusion therapy insurance coverage is approved for my condition?

Insurance providers will often use a process called step therapy in their approval process, which requires the plan member to try one or more preferred drugs before a more expensive alternative is approved.

Therefore, the answer to this question entirely depends on your condition and insurance plan, but we are dedicated to helping you receive the treatment you need. We will work with your provider and insurance company throughout the prior authorization process, and we will keep you informed about your infusion therapy insurance coverage along the way.

What steps are necessary in the prior authorization process?

The first step in receiving infusion therapy from FlexCare Infusion Centers is for us to receive a referral from your provider that includes the prescribed medication and dosage plus other details about your medical history.

Next, our experienced team will contact your provider’s office and insurance company to verify approval for your infusion therapy.

Once we receive approval, we will schedule your first appointment to begin treatment.

What are my estimated out-of-pocket costs for infusion therapy?

Depending on the medication type and dosage, infusion therapy can cost anywhere from $200 to $1,000 per infusion. The out-of-pocket cost varies depending on your insurance plan benefits, so it’s important to understand your estimated costs.

How does infusion therapy factor into my deductible, co-insurance, or out-of-pocket maximum?

As with any medical service, infusion therapy insurance coverage may not start until you have met the annual deductible for your insurance plan. The deductible is the amount you pay for covered healthcare services before your insurance plan will provide coverage.

After you meet your deductible, your insurance plan will typically cover a percentage (80%, for example), and you will be responsible for paying the co-insurance amount (20%, for example). If you have dual coverage insurance (like Medicare and a supplemental plan), you may not have any out-of-pocket costs if both insurance companies authorize the infusion therapy.

Finally, once you have paid the out-of-pocket maximum for the benefit year, your insurance plan will pay 100% of any remaining covered healthcare costs. The out-of-pocket maximum varies depending on your specific insurance plan.

FlexCare Infusion Centers is here to help

Our team is here to help guide you through the process and will work with the referring provider’s office to gather details and submit any prior authorization paperwork required by your insurance company. We have insurance experts on our team, and we can help you better understand the process and how to get started with insurance coverage for infusion therapy.

Contact us if you have any additional questions about infusion therapy insurance coverage, or want to discuss your specific needs. A member of our team will be happy to assist you.

Cecilia Wilborn, Operations

Derrick Swetlishoff

VP of Managed Care & Contracting

Derrick Swetlishoff joined FlexCare in December 2023 and is thrilled to be part of this talented and innovative team. Derrick comes to FlexCare with over 15 years in the home infusion and specialty pharmacy contracting space. Derrick obtained his bachelor’s degree from the University of British Columbia and his master’s degree in health administration from the University of Missouri.

Derrick and his wife, high school son, and pet rabbit live in Phoenix, Arizona. While home life today is driving back and forth to high school varsity and club swim practices to support his son’s competitive swim ambitions, Derrick finds time to run, play golf, and is blessed to enjoy travel off the beaten path with family. Derrick stays involved in the community with Church and Brophy College Preparatory.

FlexCare is not currently accepting referrals for Benlysta due to a national backorder issued by the manufacturer (GSK). Our team is currently unable to determine the duration of this shortage and is recommending steps be taken by patients and providers to transition to an alternative therapy. Please close this box to view referral forms or possible alternative therapies. If you would still like to access the Benlysta referral form please click here. 

Cecilia Wilborn, Operations

Cecilia Wilborn

Operations Director

Cecilia Wilborn joined FlexCare in early 2022 as Operations Manager and assisted in the achievement of the organization’s accreditation before assuming the role of Operations Director in 2023.

Cecilia earned her bachelor’s and master’s degrees from the University of Kansas – Rock Chalk Jayhawk! She brought to FlexCare 10 years of experience in infusion therapy operations, specializing in data organization and analysis, quality assurance for clinical documentation, and editing and proofing of publications.

Cecilia currently resides in Kansas with her husband, son, and spoiled pets. In her spare time, she loves trail running, baking, and traveling. She and her husband love traveling so much that in 2021 they lived in a small travel trailer with their cat and dog for six months, visiting 47 states and 41 national parks.

Aaron Smith, CEO & Co-Founder

Aaron Smith

CEO, Co-Founder

Aaron Smith partnered with Callie Turk to start FlexCare Infusion Centers after learning firsthand the profound impact specialty infusion can have on patients and the challenges they often encounter on the journey to effective treatment. There is an unprecedented opportunity to improve access, delivery, and outcomes through better communication, technology, and operations. At FlexCare Infusion Centers, his team works hard to make the changes the patients deserve to see.

Aaron joined the healthcare sector 25 years ago when he co-founded a disease management software company focused on patient outcomes collection and ambulatory clinic accreditation. He entered population health through an acquisition of Healthways and later entered specialty medications with Briova – an Optum company. His FlexCare team routinely makes the impossible possible through expertise, good process, cutting edge technology, data-driven decision making, and a lot of listening.

Makenna Lang, Director

Makenna Lang

Director of Clinical Services

Makenna Lang joined FlexCare in 2021 as the Managing Nurse Practitioner in Birmingham. In 2023, she assumed the role of National Director of Clinical Services. Makenna oversees protocol optimization, patient safety, and clinical procedures.

Makenna holds an MSN and FNP-C certification from Samford University. Previously, Makenna worked as an ENT nurse before earning her certification from the American Academy of Nurse Practitioners (AANP) in 2018.

Makenna is married to Wes, and together they have two cats, Ralphie and Beans. She enjoys going to concerts, trying new restaurants, playing trivia and board games with friends, and has recently taken up skateboarding as a hobby.

Heather Randel, Director

Heather Randel

Director of Revenue Cycle Management

Heather Randel joined FlexCare in 2020 and led the development of the Intake team before taking over Revenue Cycle Management in 2022. Heather has 10 years of medical RCM experience in ambulatory, specialty pharmacy, and home infusion. Previously, Heather was the Assistance Director of RCM in Intake for a Specialty Pharmacy and Home Infusion service in Kansas.

Currently, Heather oversees RCM for FlexCare’s ambulatory infusion services and specialty pharmacy. She lives in Olathe, KS with her husband and two children.

Rebekkah Jackman, Director

Rebekkah Jackman

Director of Patient Access

Rebekkah Jackman joined FlexCare Infusion Centers in 2019 as a Managing Nurse Practitioner and Specialty Biologics Clinical Reviewer before assuming the role of Director of Patient Access in 2022. Rebekkah heads FlexCare’s industry-leading Intake team and ensures FlexCare patients experience the shortest time to treatment.

Rebekkah graduated from the University of Oklahoma Health Sciences Center where she earned her Master of Science Degree in Nursing with a Family Nurse Practitioner emphasis. She has over 16 years of experience in patient care and is passionate about infusion therapy and best serving our patients.

Rebekkah lives in Oklahoma City with her 3 kids and her dog. When she’s not keeping busy with her kids, you can find her in her craft room.

Matthew Holden, VP Operations

Matthew Holden

Vice President of Operations

Matt Holden is an acute care Nurse Practitioner with over a decade of committed service to the patients in his community. Matt joined FlexCare in 2021 as a Managing Nurse Practitioner and led the launch of the first FlexCare location in Alabama before assuming the role of Vice President of Operations in 2023.

Matt received his BSN from Auburn University before earning his MSN from Vanderbilt University. His experience includes Intensive Care, Transplant Medicine, Cardiothoracic Surgery, and Outpatient Care. Prior to joining FlexCare, Matt developed and launched two new service lines for an outpatient cardiology group in Alabama.

Matt and his wife Rachel reside in Birmingham, AL with their two pets, Addie and Jenkins.

Austin Wickersham, VP of Technology

Austin Wickersham

Vice President of Technology

Austin Wickersham joined FlexCare in 2020 as a software consultant before assuming the role of Vice President of Technology in 2021. He led the initiative to build a custom-developed enterprise software solution that supports and enhances FlexCare’s vital Intake team, and later led the projects to create data and reporting systems to support all departments. He oversees FlexCare’s software, data, IT, and communications projects.

Austin graduated from the University of Oklahoma with a degree in mechanical engineering. His focus on electromechanical systems quickly led to a passion for automation and building software and data solutions. After gaining experience as a software and applications engineer, he started a software consulting company and has launched several enterprise web, desktop, and mobile applications.

Austin lives in Oklahoma City with his wife, Skye, and two kids. In his free time, you can find him on the running trail, golf course, or playing games and sports with his family and friends.

Rick Yerondopoulos, Executive VP

Rick Yerondopoulos

Executive Vice President, Pharmacy

Rick Yerondopoulos professional trajectory took him into leadership just 3 years after obtaining his Doctor of Pharmacy (Pharm.D.) from the University of Arizona. His desire to be a business leader in the world of pharmaceuticals and operations drove him to complete two post-graduate residencies in Milwaukee, WI, with a heavy concentration on administration leadership.  Rick was selected to represent the state of Wisconsin in a joint venture with the state of Iowa at the 2007 Young Pharmacy Leaders Conference.

After a successful launch to his career in Milwaukee, WI, Rick returned to Arizona to be closer to his extended family.  In Arizona, he oversaw all pharmaceutical operations of the hospital-based outpatient clinics at HonorHealth, where he met his future business partner, Mark Kharoufeh.  Rick and Mark co-founded InfuseAble Care in Scottsdale, AZ, in 2020.  When FlexCare acquired InfuseAble Care in 2021, Rick transitioned to EVP of Pharmacy, leading the supply chain and procurement initiatives across the enterprise.  With the recent acquisition of a specialty pharmacy, Rick extended his purview to include oversight of this valuable service line.

Rick currently resides in Scottsdale, AZ with his wife.  His son attends Northern Arizona University in Flagstaff, AZ.

Mark Kharoufeh, Executive VP

Mark Kharoufeh

Executive Vice President, Business Development and Expansion

Mark Kharoufeh began his journey in healthcare almost 30 years ago as a pediatric oncology nurse at Los Angeles Children’s Hospital. His evolution in healthcare through various clinical, leadership, and executive roles and a passion for customer service led him down a successful path of business operations. In 2012, Mark was a finalist for AZ Business Magazine’s “Healthcare Professional of the Year” for his leadership in an all-inclusive care under one roof ambulatory healthcare service model. Mark obtained his MBA from Grand Canyon University in 2015 and completed the University of Arizona Eller Executive Leadership Program in 2019.

Mark’s dedication to enhancing access to healthcare and a model that always places the patients and their caregivers at the center of every visit was the impetus for teaming up with Rick Yerondopoulos and establishing InfuseAble Care in November 2020. Through Mark and Rick’s reputation in Arizona for reliable and service-oriented healthcare, InfuseAble Care’s brand quickly became the trusted ambulatory infusion center for physicians to refer their patients to around the state. Mark and Ricks’s goals of scaling InfuseAble Care nationally came to fruition upon meeting Aaron Smith, Callie Turk, and Adam Midkiff of FlexCare and RC Capital and ultimately joined FlexCare Infusion via acquisition in December 2021.

Since uniting with FlexCare to provide a reimagined infusion experience across the country, FlexCare has grown to 30 ambulatory centers across three states.

Mark currently resides in Litchfield Park, AZ with his wife, two sons, daughter, and labradoodle Eevee.

Adam Midkiff, CSO

Adam Midkiff

Chief Strategy Officer

Adam Midkiff joined FlexCare in 2023, though he has been involved with the organization from the early stages. He is excited by FlexCare’s mission to provide better access and high-quality care to patients in cost appropriate settings. Prior to joining FlexCare, Adam was a private equity investor with RC Capital, and he helped architect the partnership between FlexCare and RC. Prior to Adam’s experience in healthcare private equity, he was an investment banker in New York City and involved in numerous M&A and capital raising transactions.

Adam currently resides in Cincinnati, OH with his wife and two kids. He serves on the board of the Cincinnati Healthcare Professionals Network, a group of healthcare leaders with a common goal to advance healthcare innovation within the Cincinnati ecosystem. He graduated from the University of Kentucky with a degree in finance. In his spare time, Adam can be found on a soccer field or a golf course.

Jack Weston, CFO

Jack Weston

CFO

Jack Weston joined FlexCare in 2023, after most recently serving as CFO and COO of Lighthouse Behavioral Health Solutions in Central Ohio. Lighthouse focuses on improving the lives of those suffering from substance abuse disorder by combining a suite of services in an outpatient setting along with recovery housing. Prior to Lighthouse, Jack had stints in corporate accounting and finance roles at PricewaterhouseCoopers, Omnicare, and Procter & Gamble. Additionally, he embarked on an entrepreneurial journey over the last decade, beginning with a hospitality business that has grown from a single, urban sports bar to 8 bar, restaurant, and brewery locations opened in 10 years. He also opened and sold a boutique fitness studio.

Jack graduated from Miami University with bachelor’s and master’s degrees in accounting. He resides in Cincinnati, OH, where he can often be found on the golf course or trying to stay active by chasing around his young kids with his wife, Anna.