We Walk You
Through the Steps
The healthcare coverage process consists of several steps. Most may be unknown to you because they are usually handled by the doctor’s office. Even if you never have to navigate these steps yourself, it can be helpful to understand them. They include Benefits Investigation, Prior Authorization, and Claims Appeal. The chart below will help you see how they fit into the process.
Example Map of Patient Reimbursement Process
You visit your doctor and receive medical care.
Doctor examines you and makes diagnosis/prescribing decision.
Office staff asks for your medical insurance information. BMS Access Support offers services that could help your doctor confirm your coverage for your prescribed BMS medication.
Benefits Investigation: After you and your doctor have decided on a treatment, we can help you understand the benefit that is available through your insurance coverage. First, there will be some paperwork required. Then, BMS Access Support can review your coverage for BMS products that are available through your health plan. BMS Access Support can also help find other sources of coverage.
Prior Authorization: Some health insurers require a pre-approval (known as a prior authorization) before they will cover certain items or services. If this is the case, it is up to you and your doctor to prepare and submit the proper documents—BMS Access Support can help navigate the process. In the event that a prior authorization is denied, you and your doctor can appeal.
if COVERAGE is denied
Almost all health insurers have a special process to appeal a coverage decision. BMS Access Support can assist in navigating the appeals process. If we do, it is up to you and/or your doctor to prepare and submit documents to support the appeal. Also, Bristol-Myers Squibb
cannot guarantee the outcome of appeals assistance.
- Office schedules an appointment with you and you see your doctor for treatment.
- Office submits a claim to your medical insurance carrier for payment or gives you a prescription to take to your pharmacy.
- Claim is processed by insurance carrier.
- Doctor or pharmacy receives payment.
If You Have Coverage and Out-of-Pocket Costs