Ep. 88 - How to Get Your Meds Approved: Appealing Insurance Denial
Part of the series: Allergy, Asthma & Immunology Innovations Podcast
This podcast was made in partnership with Allergy & Asthma Network and in collaboration with the National Association of Medication Access and Patient Advocacy (NAMAPA).
We thank Amgen for sponsoring this episode. While they support the show, all opinions are our own, and sponsorship doesn’t influence our content or editorial decisions. Any mention of brands is for informational purposes and not an endorsement.
LISTEN TO EPISODE 88:
Has your medication been denied? Now what?
Before patients can access medications—whether it’s inhalers or biologic therapies—they often have to jump through many hoops to get insurance approval. Navigating the world of health insurance approvals for medication can be overwhelming for both patients and providers. In this episode, we break down what to expect, what you can do, and how to advocate for yourself throughout the process.
Lacey Varnon from the National Association of Medication Access and Patient Advocacy (NAMAPA) joins Dr. G and Kortney to dive into the complex world of health insurance. Lacey shares insights into common reasons for medication denials, how to appeal them, and how patients and healthcare providers can work together for better outcomes.
What we cover in this episode about health insurance approvals for medications:
Health Insurance Basics: Understanding essential terms like payer and formulary.
Navigating Insurance Approvals: Tips for a smoother process, understanding prior authorization, and common reasons for medication denials.
Teamwork Between Patients and Providers: How patients and doctors can collaborate to improve chances of approval and streamline the documentation process.
The Appeals Process: A step-by-step guide to appealing denials and ensuring access to necessary treatments.
Support Programs & Resources: Insights into sample programs, bridge programs, and tools to help patients through the approval process.
About our health insurance expert - Lacey Varnon
Lacey Varnon, ADN, PACS, BCPA, is the vice president of NAMAPA. She specializes in medication access and the buy-and-bill process. With her clinical and administrative experience, she helps physicians and their staff streamline their biologic processes. Lacey is passionate about empowering Care Coordinators with the tools and knowledge they need to excel in their roles.
More resources about biologic therapies and the conditions they treat:
Timestamps
Navigating health insurance approvals - episode timestamps
01:25 Introduction to Lacey Varnon & NAMAPA
03:24 Explanation of the term "payer"
04:14 Streamlining the approval process from the first appointment
05:01 Explanation of a formulary
08:26 Common reasons for medication denials
10:00 Explanation of prior authorization
13:33 Patient vs. doctor responsibilities in documentation
16:24 The burden of insurance on providers' workload
18:41 Working with your provider on authorizations
19:58 Summary of the doctor’s role in the authorization process
21:06 Overview of the appeals process
24:46 Understanding Sample Programs and Bridge Programs
26:51 Resources for navigating health insurance
29:28 Finding positives in medication denials
