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Appeal Your Infusion Therapy Denial

When your doctor orders infusion therapy, insurers shouldn't stand in the way.

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Understanding Your Infusion Therapy Denial

Insurers deny infusions due to cost, preferred site-of-care, or claims of "non-medical necessity." A strong appeal can reverse this.

Common Reasons for Denial

  • ! Not medically necessary
  • ! Wrong site-of-care (home vs hospital)
  • ! Step therapy required first

How We Help

We help you explain your diagnosis, risks of delaying treatment, and why the ordered site-of-care is necessary.

Start your infusion appeal.

Some Types of Evidence We Can Use For Supporting Your Appeal

✓ Timely administration of infusion therapies reduces disease activity and prevents irreversible organ damage in many conditions.

✓ Site-of-care should be determined based on clinical safety and stability, not solely cost.

✓ Step therapy policies should not override evidence-based prescribing when prior treatments have failed or are contraindicated.

While You're Fighting Your Denial

Talk to your provider about these options that might help bridge the gap:

→ Some infused medications have subcutaneous versions that may have different coverage status.

→ Ask your provider about biosimilars which may be on a preferred tier with your insurer.

→ Home infusion vs. hospital/clinic infusion may have different coverage — discuss options with your provider.

Patient Assistance & Copay Programs

These programs may help reduce your costs while you appeal:

EntyvioConnect (Entyvio) ↗

Eligible patients may pay as little as $5 per dose. Max $20,000/year benefit for commercial insurance.

Janssen CarePath (Remicade, Simponi Aria) ↗

Copay assistance and patient assistance programs for J&J infused medications.

Genentech Access Solutions (Rituxan, Ocrevus) ↗

Copay assistance and patient assistance for Genentech infused therapies.

Immune Deficiency Foundation Resources ↗

Comprehensive list of manufacturer programs and independent foundations for infusion assistance.

Eligibility requirements and program terms may change. Please verify current details directly with each organization.

Patient Advocacy & Support Organizations

These organizations provide education, support, and advocacy for patients:

Global Healthy Living Foundation ↗

Nonprofit advocating for patients with chronic conditions requiring infusion therapy.

Frequently Asked Questions

Insurers sometimes require infusions at certain locations, like outpatient centers instead of hospitals. Your appeal can explain why the chosen setting is safer or medically necessary.

Yes. Your appeal can explain why the prescribed medication is clinically appropriate and why alternatives may be less effective or riskier in your case.

Make that explicit. Appeals are stronger when they clearly describe the risks of delay, including organ damage, flare-ups, or hospitalizations.

Ready to Fight Your Infusion Therapy Denial?

Our free AI-powered tool will help you generate a compelling appeal letter in minutes.

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Disclaimer: Fight Health Insurance is not affiliated with, endorsed by, or partnered with any pharmaceutical manufacturer, healthcare provider, medical device company, or patient assistance program. All information provided is for educational and informational purposes only and does not constitute medical or legal advice. Please consult with your healthcare provider regarding treatment options and with your insurance company regarding coverage decisions.