New Health Insurance Requirements for Infusion Therapy Site of Service

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Several of the largest commercial health insurance companies have recently enacted policies intended to steer patients away from hospital-based facilities for the infusion of some of the most common drugs used for the treatment of auto-immune and inflammatory conditions. The Arise Infusion Therapy team helps to manage all issues affecting insurance pre-authorization, payment arrangements and scheduling to ensure a smooth and pleasant infusion experience.

Medical Injectables and Oncology Trend Report, ICORE Healthcare determined that the cost of providing infusion therapy in an outpatient center such as Arise Infusion was roughly half the cost of providing the same treatment in a hospital.

Several of the largest commercial health insurance companies have recently enacted policies intended to steer patients away from hospital-based facilities for the infusion of some of the most common drugs used for the treatment of auto-immune and inflammatory conditions. Citing significantly higher costs for care provided at hospitals, these insurers want patients to seek out less expensive settings to receive routine infusions. A common strategy employed by the payers is to require the prescribing physician to submit justification of medical necessity for hospital-based infusion. Use of hospital-based infusion centers without medical justification can result in the insurance company’s refusal to pay for treatment.

Not all infused medications have been subjected to these new rules, but many of the most popular anti-inflammatory drugs, such as Remicade (Infliximab), are frequently cited. It is best to check directly with your insurance company to determine if they have instituted restrictions on hospital-based therapy and for a list of drugs included in their restrictions.

ARISE INFUSION THERAPY SERVICES has five conveniently located centers in the Washington D.C. metropolitan area that provide safe, cost effective infusion therapy for patients in need of a non-hospital based treatment option. Arise Infusion centers are modern and attractive with many amenities to ensure your comfort. Most patients prefer Arise Infusion to both hospital-based and home-based care. Emphasizing a “safety first” philosophy, Arise Infusion centers are staffed with highly trained registered nurses working under physician supervision. “Most patients find Arise to be more pleasant and more convenient than receiving care in the hospital, with no sacrifice in safety or efficacy,” states Arise Medical Director Dr. Ashley Beall, MD, FACR. “We focus on patients with auto-immune and inflammatory conditions who aren’t so sick that they need to be treated in a hospital and aren’t so frail that they require home care. The offices are bright, cheerful places where people take a break to manage their conditions so they can lead full and productive lives.”

In their 2010 Medical Injectables and Oncology Trend Report, ICORE Healthcare determined that the cost of providing infusion therapy in an outpatient center such as Arise Infusion was roughly half the cost of providing the same treatment in a hospital. This savings may directly impact the patient in the form of lower out-of-pocket expenses. With rapid growth forecasted in the number of conditions that will be treated through infusion and a specialty drug market size already over $120 billion, it is not difficult to see the vast potential for overall health care savings by infusing drugs in more cost-efficient settings.

The Arise Infusion team helps to manage all issues affecting insurance pre-authorization, payment arrangements and scheduling to ensure a smooth and pleasant infusion experience. For more information regarding Arise Infusion visit our website at http://www.ariseinfusion.com or call 240-514-5000.

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Brenda Brouillette - Public Relations
@WashDCArthritis
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Arthritis & Rheumatism Associates, PC
since: 06/2013
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