Step-by-step appeal worksheets

Our checklists increase the likelihood of a successful appeal.
We provide a list of the key documentation needed and tips to expedite your request.

  • Become an expert on payor policies

    Economic burden of IBD

    Topics covered within this infographic include how payors are likely aware that the incidence and cost of IBD are increasing but most of the spend for IBD is in the inpatient and emergency department.

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  • Become an expert on payor policies

    Understanding payor drug use management initiatives

    In this downloadable infographic you’ll learn how several different tactics may be used as part of a drug use management strategy, the overall goal of which is to ensure appropriate medication use.

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  • Become an expert on payor policies

    Managing change in health care insurance

    Learn about challenges and solutions related to transitions in health care coverage, non-medical switching, site of care concerns, and emerging treatments.

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Test your knowledge

Test your knowledge on the above infographics and worksheets by taking this quiz. Besides being a fun way to verify your understanding, the feedback is helpful to AGA to confirm the information was presented in an easy-to-understand manner.

Submit your response to see the correct answer and how other participants responded.

Which of the following is NOT an indirect cost? *
The biggest component of spend for inflammatory bowel disease in the U.S. is for pharmaceuticals. *

Additional resources

Insights

  • Dana McCormick, RPh, FAMCP, Optum

    Senior Director, Pharmacy Advisory Services

    “I have seen the influence of specialty society guidelines on payors’ decisions. Other than randomized clinical trials, specialty societies are the first place payors go to get more information.”

  • Rocio Castrillon, MBA, @VoiceForIBD


    “Patients do tend to have more success with appeals when verbalizing the direct effects we are experiencing due to a delay in authorization. I believe having patients be able to do some of the follow-up allows for the opportunity for the patient to not only be proactive, but also not have to be sitting around waiting for an authorization to go through.”