Friday, January 22, 2010

Funding Source for Synagis Co-Pay/Deductable

For those of you that know me, you know that I'm always looking for funding sources. Every little bit helps. We don't have an extra couple thousand dollars laying around for every medical bill/item that comes up. For example, Kinnick was approved for Synagis (RSV) again this year. The pharmacy is billing my insurance $8,271.00 per shot - she gets 5 shots. That's not what my insurance company has agreed to pay. They have an agreement to pay $2,404.30 per shot. I have a $2,400.00 deductable. After the deductable is met, we have to pay 10% of the bill until we have paid $5,600.00 out-of-pocket. Medicaid nomally kicks in and pays the difference. However, this year Medicaid doesn't feel like Synagis is medically necessary. They feel like if you're over the age of 2, then it's not medically necessary - regardless of your health. So, that means that in order to get the shot, I would have to pay the full $2,400.00. Or, whatever hasn't been met on my deductable plus 10%. Someone passed on the following organization and said that they might be able to help. Well, I didn't have anything to lose, so I gave it a shot. Much to my surprise, we were approved for assistance. Kinnick will be able to get the Synagis shots again this year without any money out-of-pocket. So, I wanted to share this funding source with others that might benefit - I'm pretty sure this is nationwide.

PANF (Patient Access Network Foundation). This organization provides assistance in the form of reimbursement of out-of-pocket expenses for cetain medications covered by your insurance carrier - like synagis. You can do nearly all of the application on the phone - takes 5-10 minutes. They'll mail or fax it to you and your doctor's office (prescribing doctor) and you and your doctor can fax it back or mail it back. You have to provide proof of income - most recent tax forms and payroll stubs. If your income has changed since your last income tax, don't worry. You're allowed to provide that information. We don't qualify for anything that has income guidelines - except Minimum Alternative Tax on our Income Tax (Yippie). But, we did qualify for this. They are paying ALL of our out of pocket expenses in 2010 for synagis. Our pharmacy will collect the money directly from PANF, so we don't have to come up with the money first. It only takes about a week for the approval once they receive your forms and the doctor's copy. It's pretty quick if you use the fax.

I've heard some of you say that you're paying as much as $300 per shot this year. Please give them a call. You'll probably qualify.

1-866-316-PANF (7263). Just tell them that you want to complete an application for reimbursement for co-pay/deductable related to Synagis.

They also have a website www.PANfoundation. org - Check it out. They also help with other very expensive meds. Every little bit helps.


Laura said...

Wow I will check this out I don't know if they will pay for the liquid prevacid or not but at $60 every two weeks it adds up. Like you said it doesn't hurt to try!
I tried that website it didn't seem to work on my computer but will be making a call tomorrow because we do need one and this one sounds great, thanks for the info.

Sherri said...

You are just full on information(thanks for giving me the info too)! :D I love how you are eager to share you secrets with us! Hope all is well...and I can't wait for April to get here!

Tiffany said...

Thanks for the comment on my blog. And by no means did you offend me. I actually read to see what Kinnick is doing because she is about a year older than Randy and seems to be hitting her milestones around the same time he is.

Early intervention loaned us a stander (although it has a little more support that she would like but it was all they had available).

It's ironic that you left a comment because I wanted to email you and get your opinion based on some of your experiences. Let me know.

Cheryl Miller, RN said...

Excellent program!! However, there ARE income guidelines following the HHS Federal Poverty limits. This is need based program for those who qualify.