Upon completion of the Application to Request Benefits Verification Assistance, we will verify insurance coverage and obtain the appropriate PA form.

We will provide a Summary of Benefits, including a summary of the PA requirements. Additionally, we will transfer information provided during the patient enrollment process to prepopulate the PA form solely with basic patient and healthcare provider information.

The healthcare provider must then review, complete, and sign the PA form.^b

The healthcare provider can either request that we submit the completed, signed form directly to the patient's insurer or can submit it directly on their own.

If we submit the form, we will relay the PA results and inform the healthcare provider of any additional information required by the insurer.