Our goal is to make getting therapy easier so you can focus on feeling better. Your Coram team will help you get started – from checking your benefits to helping with prior authorizations. And below, we’ve listed answers to common insurance and coverage questions.
What’s the difference between an insurance company and health plan?
Insurance companies offer private health plans – or medical and prescriptions benefits – directly to people or through peoples’ employer (plan sponsor). The U.S. government offers public health plans – like Medicaid and Medicare – to people who meet certain terms.
Do all private health plans pay for home infusion and tube feeding therapy?
Most private plans have benefits – or coverage – for home infusion and tube feeding. But the amount of coverage and how it’s billed may vary from plan to plan. For example, supplies and nursing care may need to be billed under medical benefits. But infusion medication or formula may need to be billed under prescription benefits.
What about Medicaid’s and Medicare’s coverage?
Most Medicaid plans help pay for home infusion and tube feeding therapy. Coverage amounts vary by state. Medicare also covers some or all parts of home infusion and tube feeding therapy for covered people age 65 and older. But the coverage depends on certain factors. Click here to read our article, About Medicare and home infusion care, to learn more these benefits.
What does “in-network” mean?
Insurance companies contract with health care providers – like pharmacies or hospitals – to offer people the best care at the best possible cost. Contracted providers are called “in-network.” Out-of-pocket costs are your portion of the total costs. And you’ll typically pay less out of pocket for in-network care.
Is Coram an in-network provider with my insurance?
Most likely, yes. We’ll check your benefits, but Coram is in-network for infusion care with most national and local, private health plans
Can Coram still be my infusion provider if it’s not an in-network pharmacy?
Coram may be an in-network infusion provider under your medical benefits, but not an in-network pharmacy under your prescription benefits. If so, you’ll get your medication through an in-network pharmacy. We’ll still coordinate, administer and monitor your care.
My doctor ordered my therapy. Does this guarantee coverage?
Your health plan may require an approved prior authorization – or PA – before authorizing payment for infusion services. Here are some helpful facts:
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For PA approval, your doctor or provider must submit criteria or give a reason that shows why you need your therapy to treat your condition.
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If criteria is missing or doesn’t meet the requirements, the PA – and payment – will be denied or delayed. This means you won’t get your therapy.
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Coram will work closely with your doctor and health plan to help you get the therapy you need, when you need it.
Are there any other rules or requirements?
Health plans may have other rules or criteria for home nurse visits and other clinical services. These may affect how and where you receive therapy. For example, your benefits may only cover certain infusions at an outpatient facility. We’ll explain these rules and help set up services based on your benefits.
Understand how we’ll help you get the most from your benefits and guide you through the payment process. Click here to read our article, Benefits and payment support. Or to ask your Coram team questions, call us.
This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about your medical condition and prior to starting any new treatment. Coram assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result.
Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.