Dependent Receives Excluded Medication After Coverage Denial

The Client

Office Furniture Solutions Company with over 30 enrolled employees

The Challenge

A member’s dependent needed a specific type of insulin that unfortunately was excluded under their plan. In order to receive their medication, the dependent requested their medical care provider send an appeal to their insurance carrier. Unfortunately, the appeal was denied.

The Solution

Caravus advocates stepped in, guiding both the client and the dependent through next steps. The team walked the client’s HR department through the process of submitting the second appeal request, and followed up regularly with both the carrier and the dependent regarding the appeal’s status.

The Outcome

The client’s appeal was ultimately approved by the carrier, and the dependent received access to that specific insulin brand for the next year. In addition to receiving their medication, the advocacy team and client created a documented, repeatable process that will be used year after year – ensuring the dependent will always have access to the prescription they need.