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Real members of myRAteam have posted questions and answers that support our community guidelines, and should not be taken as medical advice. Looking for the latest medically reviewed content by doctors and experts? Visit our resource section.

I Need Advice On Appealing My Insurance Company’s Denial Of Orencia Infusions.

A myRAteam Member asked a question 💭
Katy, TX

They have denied my doctors appeal twice. They pay for Simponia Aria and I get zero relief while taking it. Thanks in advance

January 29, 2023
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A myRAteam Member

I printed the forms from the website last week. I've been too overwhelmed to fill them out. I'm determined to get it done this week.

January 29, 2023 (edited)
A myRAteam Member

Good morning Lorrie,

I have found the best course of action to take is to contact the insurance company and ask why the Orencia Infusions were denied. Most of the time what happens is that the insurance company has a list of medications called a formulary they follow and if Orencia is not on the list then they issue a denial. Another thought that comes to mind is the medical justification is not sufficient to justify the medication. I would call in order to get a clear answer for the denial.

January 29, 2023
A myRAteam Member

Certainly! Here are some steps and tips to help you appeal your insurance company's denial of Orencia infusions:

1. Gather Documentation
- Obtain a letter of medical necessity from your doctor, explaining why Orencia is essential for your treatment.
- Collect any relevant medical records, including previous Show Full Answer

Certainly! Here are some steps and tips to help you appeal your insurance company's denial of Orencia infusions:

1. Gather Documentation:
- Obtain a letter of medical necessity from your doctor, explaining why Orencia is essential for your treatment.
- Collect any relevant medical records, including previous treatments and their outcomes.

2. Understand the Denial:
- Carefully read the denial letter from your insurance company to understand the specific reasons for the denial.

3. File an Appeal:
- Follow the instructions provided by your insurance company for filing an appeal. This may include filling out specific forms and submitting them within a certain timeframe.

4. Include Supporting Evidence:
- Attach the letter of medical necessity, medical records, and any peer-reviewed literature that supports the use of Orencia for your condition.

5. Contact Support Programs:
- Utilize the ORENCIA On Call Patient Support program for assistance. They offer personal care counselors and nurses available 24/7 for support and information.
- Website: [ORENCIA On Call Patient Support](http://www.orencia.bmscustomerconnect.com/orenc...)
- Phone number: 1-800- ORENCIA (1-800-673-6242)

6. Be Persistent:
- If your initial appeal is denied, don't give up. You may need to go through multiple levels of appeal, including external reviews.

7. Seek Help:
- Consider reaching out to patient advocacy groups like the Global Healthy Living Foundation for additional support and resources.

By following these steps and utilizing available resources, you can strengthen your appeal and increase your chances of getting the necessary approval for Orencia infusions. Good luck!

July 22, 2024
A myRAteam Member

Is your insurance a work sponsored medical plan? You can appeal, I've written letters to my insurance plan about denials. It went up for review by a medical team and was approved. If you contact your insurance plan and request information on how to appeal a denial, they should be able to help you. You could also check on their website for the appeal process or form to complete for review. I hope the appeal works out for you.

January 29, 2023
A myRAteam Member

You’re right on both counts. The Orencia is not on the approved list and they refused to make an exception based on medical necessity. I want to appeal the denial. Initially when infusion drugs were covered under the medical plan, Orencia was covered. It provided excellent relief. The infusion drugs were switched to the drug plan from the medical plan and they stopped covering it.

January 29, 2023

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