My claim for
Actemra
was denied.Now what?
We know how frustrating, scary, and confusing this can be, but you’ve come to the right place. First and foremost, it’s important to know that you can appeal. It’s your right!
Didn’t go to medical school or work for a health insurance company? That’s ok. We did. Whether you’re trying to challenge a claim denial, prior authorization, or request a formulary exception, we are here to help.
Claimable can help you appeal. Why was your claim denied?
Learn more about Actemra
What is Actemra used to treat?
(also known as) can help . It's taken as . It works by .
0
What do doctors usually consider before trying ?
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What are the coverage criteria for Actemra?
For Actemra to be approved for preventing , you need to have:If this describes your symptoms, and you do not have one of the excluded conditions, you may be a good candidate for Actemra approval. However, your treatment history matters. Often you will need to have tried other treatments before your insurance company will approve Actemra. The exact requirements can vary depending on the insurance plan, but below are the general guidelines: If you meet the above criteria, you will usually get an initial authorization, which will be active for on average. To continue receiving insurance coverage for Actemra it means:
What you can do to help your case?
Make sure your doctor is recording all different types of migraines that you suffer from. For instance, if you have migraines with aura and also have episodes without aura, make sure both are included in your records. Once you get a diagnosis of chronic migraine, however, that difference in coding becomes less important.
Track your migraines. Keep track of how often your headaches happen and their impact on your life (having to miss work or school, skip appointments, avoid driving, etc)
Track the drugs you’ve already tried. This improves your ability to say whether you can skip ahead in the process, especially if your doctor makes note of it.
Note if you have had headaches from your medications, or “medication overuse headaches”. Medications like Aimovig both help reduce headaches and do not cause an overuse headache, meaning they might be the best option for people with medication overuse headache.
Get help writing your appeal. These are complicated documents to write well. But we can take your details, cite the evidence, and improve your chance of turning that denial into an approval. We can help. Start your appeal today.
Claimable makes it easy to appeal denied claims
1
Upload denial letter
All we need to get started is your denial letter and insurance information
2
Answer simple questions
We’ll ask you a few questions about the events leading up to the denial
3
Generate expert appeal
We compose an evidence-based appeal, supported by medical history, clinical research and policy details
4
Submit & support
We mail your appeal and support you through the process
Patient success story
Diagnosis
Treatment
Denial reason
Health plan
Gender
Age
Health History:
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Appeal Summary
Appeal Successful
References
Ailani J, Burch RC, Robbins MS; Board of Directors of the American Headache Society. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache. 2021;61(7):1021-1039. doi:10.1111/head.14153
Ailani J, Burch RC, Robbins MS; Board of Directors of the American Headache Society. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache. 2021;61(7):1021-1039. doi:10.1111/head.14153
Ailani J, Burch RC, Robbins MS; Board of Directors of the American Headache Society. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache. 2021;61(7):1021-1039. doi:10.1111/head.14153
Ailani J, Burch RC, Robbins MS; Board of Directors of the American Headache Society. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache. 2021;61(7):1021-1039. doi:10.1111/head.14153
Choose a denial
reason to appeal:
Why It's common for
Actemra
How to appeal
Why It's common for
Actemra
How to appeal
Why It's common for
Actemra
How to appeal
Why It's common for
Actemra
How to appeal
Why It's common for
Actemra
How to appeal
Why It's common for
Actemra
Some doctors and their staff do not know which insurance plans require Prior Authorization for which medications.
How to appeal
Ask your doctor’s office to submit an initial Prior Authorization request to your insurance company. You can also try sending an appeal that details all the treatment options you and your doctor have already tried. That said, a doctor’s office might get a faster result.