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 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 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, coverage for infusion therapy 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 or want to discuss your specific needs. A member of our team will be happy to assist you.