Insurance
WE are pleased to ACCEPT:
Private insurance (such as Cigna, United Healthcare, Elan, etc.)
Medicare (We require that our patients apply for Medicare Part D coverage)
VI Medical Assistance Program (MAP)
and uninsured, self-pay patients…
important notes from our team about insurance coverage:
A prior authorization from the insurance provider is oftentimes required before treatment can be initiated with most medications. Prior authorizations may take anywhere from 24 hours to 30 days.
In the event that a prior authorization is denied, we will most likely appeal the denial or propose a new treatment regimen. This will delay the start date of treatment.
Oral medications that cannot be supplied by local pharmacies are ordered through our specialty pharmacies on the mainland and shipped to our office for our patients’ convenience and care. The patient is responsible for paying the copay for the medication directly to the specialty pharmacy, there is no charge from our office. If your copay is not affordable, please state such to the pharmacy and we will make sure to help you to apply for grants and patient assistance programs.
Cancer Support VI is a proud supporter of all of our cancer patients and offers annual grants to assist with medical expenses.
We are also proud to have a staff of oncology nurses who are experienced patient navigators and knowledgeable about many patient assistance programs, grants, and charities that assist patients from all financial circumstances to obtain the care and medications required for their diagnoses. If you have questions specific to your medication and finances, please speak to one of our nurses.
Copayments are due at the beginning of each visit.
For self-pay patients, a menu of services will be provided at your initial consultation and payment will be due at the end of each visit.
What happens when a medication is too expensive or isn’t covered?
We have access to a handful of additional patient assistance programs, grants, and manufacturer programs that assist our patients. Our nurses and office manager, and even the specialty pharmacy that we utilize, are happy to assist you in applying for these programs. Please let us know when the copay for a medication is too high.
What happens when a medication is not covered under my insurance benefits?
If your prescribed medication is denied, we will more than likely appeal the denial or pursue another treatment plan. Please note: this will delay your treatment start date. If you have Medicare, your Part D coverage will cover your medication. For this reason, we require that all Medicare patients apply for Part D during open enrollment each year.
What if I don’t have insurance?
Our nurse navigators are happy to assist all self-pay patients as much as possible to receive grants and apply for special programs. There are many programs that provide subsidized or free medications. We will provide you with your self-pay menu of services at your first appointment in order to be up front about the costs you can expect for doctor’s visits, injections, and/or infusions. Payment will be due at the end of every visit. If you would like to make a payment plan, please speak directly with the Office Manager.
What is the Medicare Donut Hole?
The Medicare Donut Hole is a coverage gap after the initial coverage where the patient has paid a copay on up to $5,030 of covered drugs until the patient reaches catastrophic coverage, where the Medicare plan will cover 100% of covered drug costs.
Most Medicare Part D (pharmacy) plans have a coverage gap (called the "donut hole"). This means there's a temporary limit on what the drug plan will cover for drugs. See the illustration on the right for an idea of what this looks like.
The deductible resets on January 1st and once the patient has spent $5,030 on covered drugs in 2024, the patient will enter the coverage gap. (This amount is subject to change each year.) Not everyone will enter this coverage gap. Until the patient reaches the threshold of $8,000 (for 2024), the patient will pay a 5% coinsurance rate. After reaching the $8,000 threshold, the patient will be out of the coverage gap and the patient will enter “catastrophic coverage” until the end of the year. There will be no out-of-pocket costs in this stage, but that coverage will expire on December 31st and the patient’s plan will reset on January 1st.
Please note: patients with Medicare who get “Extra Help” paying Part D costs will not enter the coverage gap.
Are there any pharmaceutical assistance programs for Medicare patients in the VI?
Yes. In the event that you need additional assistance, please consider the SPAP program.