Patient Insurance Coverage
Frequently Asked Questions
Is BT covered by insurance?
Coverage policies vary by payer. For a list of plans currently covering BT, see Insurers and Health Plans Covering BT. As insurance companies update their policies throughout the year, if you do not see your insurance on the list, it does not mean that they won’t cover BT as a treatment. Your BT Physician and their staff can work with you to request coverage of your BT Procedure.
How can I find out if my insurance company will cover BT?
Contact your insurance company to review your coverage of benefits. Your plan may require a Prior Authorization and/or allow for a Pre-determination. This provides your Health Insurance company the opportunity to evaluate the treatment plan for medical necessity. At times it can also be a requirement of the insurance plan for your provider to provide a specific procedure.
What if my insurance company states they do not cover BT?
Even if your insurance company has stated that BT is not covered by your plan, it is possible to request coverage if your physician considers BT a medical necessity.
How can I help prove my medical necessity for BT?
Provide your physician with a letter to send to your insurance company. In this letter, provide an accurate, detailed overview of how severe asthma affects your quality of life. Examples may include:
• Experiencing severe asthma attacks
• Frequent trips to the ER or hospital for asthma symptoms
• List of medications that you take and any adverse side effect
• Missed time from work or school due to asthma
• Difficulty perform daily activities such as exercising, walking, or sleeping
• Any additional ways that severe asthma negatively affects your life
What if my health insurance company has denied coverage for BT?
If your health insurance company has denied coverage for BT, you may want to appeal the denial by:
• Contacting your physician’s office and asking if they will submit an appeal on your behalf.
• Contacting your insurance company and asking to appeal the decision directly. Your insurance company will be able to provide you with next step instructions.
Is there a financial assistance program available for BT?
There is no formal patient financial assistance program available for the BT procedure.
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Help improve coverage for BT
(1) Medicare includes Bronchial Thermoplasty as part of a covered benefit category and has approved the procedure for qualified patients nationwide, but does not have a formal written coverage policy for the procedure. Healthcare facilities and physicians treating patients who have Medicare coverage will need to submit a claim to their local Medicare contractor.
(2) Medicaid includes traditional Medicare and Primary Care Case Management (PCCM) Medicare.
(3) Independence Health Group, selected plans: Independence Blue Cross, AmeriHealth PA, AmeriHealth NJ, and Keystone Health Plan East HMO
(4) Health Care Service Corporation operating through BlueCross BlueShield plans in Illinois, Montana, New Mexico, Oklahoma, and Texas.
Brief Statement of Relevant Indications for Use, Contraindications, Warnings, and Adverse Events: The Alair™ Bronchial Thermoplasty System is indicated for the treatment of severe persistent asthma in patients 18 years and older whose asthma is not well controlled with inhaled corticosteroids and long-acting beta-agonists. The Alair System is not for use in patients with an active implantable electronic device or known sensitivity to medications used in bronchoscopy. Previously treated airways of the lung should not be retreated with the Alair System. Patients should be stable and suitable to undergo bronchoscopy. The most common side effect of BT is an expected transient increase in the frequency and worsening of respiratory-related symptoms. ENDO-551804-AA
As with any procedure, there are risks, and individual results may vary. The most common adverse event of BT is a temporary worsening of respiratory-related symptoms. These events typically occur within one day of the BT procedure and usually resolve within a week with standard care. There is a small risk (3.4% per procedure) that symptoms may require hospitalization.1
- Castro M, et al, for the AIR2 Trial Study Group. Am J Respir Crit Care Med. 2010;181:116-124.