Bristol-Myers Squibb Access Support® is committed to helping appropriate patients get access to our medications by providing reimbursement support services for healthcare offices.
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Almost all health insurers have a specific process to appeal an unfavorable coverage decision. Bristol-Myers Squibb (BMS) Access Support can assist in navigating the appeals process. However, the preparation and submission of documents to support the appeal is the responsibility of the patient and/or healthcare provider.
Bristol-Myers Squibb and its agents make no guarantee regarding the outcome of appeals assistance.
When you’re filing an appeal, keep in mind:
Each plan has its own process and timeline for appeals. The appeals process for Medicare Part B contractors is determined by the Centers for Medicare and Medicaid Services (CMS) and is outlined below.
Medicare has a formal appeals process that is relatively easy to initiate but must be managed carefully to ensure that the appeal is properly prepared and that timely filing deadlines are not missed. Many non-Medicare health insurers follow similar procedures.
There are currently five levels of appeal in the Medicare Part B and Part D programs3:
Each level of appeal must be completed before the patient is eligible to advance to the next level of appeal. In addition, there are time and dollar thresholds that must be met.
1. American Academy of Actuaries. Health Insurance Coverage and Reimbursement Decisions: Implications for Increased Comparative Effectiveness Research: 2008.
2. Healthcare.gov_appeals. How do I appeal a health plan decision? https://www.healthcare.gov/how-do-i-appeal-a-health-insurance-companys-decision/. Accessed August 6, 2015.
3. Centers for Medicare & Medicaid Services. Medicare Claims Processing Manual. http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c29.pdf. Accessed August 6, 2015.
The accurate completion of reimbursement- or coverage-related documentation is the responsibility of the healthcare provider and patient. Bristol-Myers Squibb and its agents make no guarantee regarding reimbursement for any service or item.