Get your patients the treatment they need
Our appeals team overturns nearly eight out of 10 denials.
Optum Specialty Pharmacy and Optum Infusion Pharmacy Appeals Team manages the appeals process so that you don’t have to. Our team overturns nearly eight out of ten denials and has helped 2,500 patients get coverage for their medication after they were previously denied.
Meet the Optum Specialty & Infusion Pharmacy Appeals Team
The team was created in response to the changing dynamics in healthcare. At that point in time, we started to see a lot of denials and patients having difficulty getting access to the medications and treatments that they really needed.
When we get a denial on a patient, the first thing that we're going to do is review medical policies for the insurance company. Every insurance company is different and things that they ask for are going to be different and specific to each patient's plan. So, once we have that knowledge base, then we focus in on what that individual patient is experiencing, what their symptoms are, what medications they may have tried in the past are, and we write a letter that is specific to them.
I called the patient and I said, not only did we get it approved, but we got it approved for you for a year. I remember saying, "That just made my day." And the patient said, "You just made my life." I get goosebumps just every time I think about it, because it's such an incredible feeling to know that you have that kind of impact. It's challenging and rewarding all at the same time.
We are an advocate for these patients. We treat them. I always think of them as my mother, my brother, sister, father, how would I like to be treated if I was in this situation? And I treat my patients the same way.
Help you and your patients can count on
Insurance denials are a common obstacle for many patients. Even patients who desperately need medication can be denied by their insurance company. That’s why our appeals team is so critical.
Our team manages the insurance appeals process so you don’t have to. With more than 100 years of combined experience, our clinicians, nurses and administrative experts work together on your patients’ behalf.
Our team helps you and your patients:
- Conduct initial clinical reviews
- Submit for prior authorization
- Review and assess any denials
- Write customized appeal letters for insurance denial
- Provide talking points to help with peer-to-peer review
Contact us today using the information below, or by completing the form on this page.
Visit: Optum Specialty Pharmacy
Visit: Optum Infusion Pharmacy