# IV Iron infusion in the office denials-Help getting denials



## perkins05 (Nov 3, 2011)

Help getting denials for j2916 in hemat/onco clinic...


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## ajs (Nov 3, 2011)

perkins05 said:


> Help getting denials for j2916 in hemat/onco clinic...



Is that from all insurance carriers, or a specific one?  What is the denial reason you are given?


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## perkins05 (Nov 3, 2011)

Cigna....

reason
it is not covered because they cover specialty and biotech drugs only under their RX benefit.  Medications are administered through Caremark Specialty Pharmacy Services.  Specialty drug charges not approved by the Caremark are not covered by the plan. 

This just started to help and we confused why...patients are upset because they had no knowledge of this either.

Any suggestions would be helpful.


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## ajs (Nov 3, 2011)

perkins05 said:


> Cigna....
> 
> reason
> it is not covered because they cover specialty and biotech drugs only under their RX benefit.  Medications are administered through Caremark Specialty Pharmacy Services.  Specialty drug charges not approved by the Caremark are not covered by the plan.
> ...



So it would appear the CIGNA is now using Caremark for pharmacy services.  You need to contact CIGNA and find out when the policy changed and what you can do for the drugs that have already been administered.  A lot of different medciations that must be administered in a physician office are going onto a specialty pharmacy list and have to be preauthorized.


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## perkins05 (Nov 3, 2011)

Thanks so much for your help....


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