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KNOW THE
INSURANCE PROCESS
Learning the ins and outs of the insurance process can be confusing at times. We’ll help point you in the right direction. Here’s what to expect when submitting for insurance coverage:
Submitting a prior authorization
Once your child is diagnosed, their doctor will submit a medication authorization request to the insurance company before starting treatment. This process is known as prior authorization (PA). It is also referred to as precertification or prior approval. It involves satisfying criteria that insurance companies require to approve growth hormone (GH) medication.
Keep your documentation in one place
Given the amount of information required to review and provide to insurance companies, prior authorization (PA) approval can take some time. Having your information organized will help you, the nurse, or the person performing the PA be more efficient. Some PAs need to be regularly reauthorized. Let your care team know if your authorization is close to ending. They can help you continue to get reauthorizations.
Once you are approved
Now, your care team can begin coordinating medication shipments and start teaching you how to administer treatment.
What if you're denied?
If your request is denied, your healthcare team can begin the appeal, a process that may involve providing the following documents:
- Letter of appeal—a counter argument of why your child needs treatment
- All denial letters from your insurance company
- Medical records, like growth charts, tests, and lab results
- Letters of medical necessity from your doctor(s)
- References to research from accredited organizations
Additional Financial Support
Many pharmaceutical companies offer co-pay support and other financial assistance to offset out of pocket costs. If you experience difficulties with authorization and appeals, see if the company that manufacturers your child’s GHD treatment offers an assistance program. Advocacy organizations are also available for help with insurance questions and appeals.
Did You Know?
Your insurance company may choose a Specialty Pharmacy as their preferred pharmacy for GH treatment. Specialty Pharmacies are designed to provide faster access to the medicine your child needs. They may also offer support services for injection training and reimbursement.
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