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About patient reimbursements
If you have a PAN co-pay grant and your provider or pharmacy doesn’t send the bill to PAN, you can pay the out-of-pocket costs yourself to get reimbursed for approved expenses using a direct member reimbursement form.
PAN is the payer of last resort, so PAN will only reimburse you if you used your insurance to pay for the medication. To be eligible for reimbursement, you must be insured, your insurance must cover the medication, and the medication or product must be listed as a covered medication for your disease fund.
What services are covered
PAN covers products that are FDA-approved or listed in official compendia or evidence-based guidelines for the specific disease fund. PAN reimburses:
All prescription medications in the disease fund formulary, including:
- Brand medications
- Generic medications
- Bioequivalent or biosimilar drugs
- Specialty drugs
Certain disease funds cover medical supplies for administering treatments and preventative vaccines.
When to submit reimbursements
If your grant is active, you may ask for reimbursements throughout the eligibility period. Grant eligibility periods are for 12 months with a look-back period of 90 days for any initial grant. At the end of the grant eligibility period, you have 60 days to submit any outstanding reimbursement requests with dates of services within the eligibility period.
PAN’s grant use policy requires patients, or their representative, to request and receive payment for a claim from PAN every 120 days to keep the grant active. If a reimbursement form or claim is not submitted and paid during that timeframe, the grant will be canceled.
Learn more about the grant use policy and what to do if you receive a reminder letter.
PAN will not reimburse:
- Eligible medications or over-the-counter products not covered by your insurance
- Eligible medications paid by the insurance payer at 100%
- Eligible medications billed only to drug discount cards and not insurance
- Medical services, such as lab work, diagnostic testing, genetic testing, ER visits, and office visits
- Medications not covered under PAN’s formulary for the relevant disease fund
To request new medication coverage for a medication not covered by your grant, you can submit an online request or call us. Note that we cannot guarantee new medication coverage.
Before you submit a reimbursement
Check your grant balance
Before submitting claims, verify your grant balance using your portal account at panapply.org. You can also call us at 1-866-316-7263 and verify your grant balance using our interactive voice response system.
Collect relevant information
Before submitting a direct reimbursement form, make sure you have the following:
- Patient contact information (name, date of birth, phone number PAN ID number, and group number)
- Name of your medication or treatment
- Where and when you got your medication or treatment
- Requested reimbursement amount
How to submit reimbursements
Download your direct member reimbursement form
If you have a PAN grant, you can ask for reimbursement for approved expenses using the direct reimbursement form. Don’t fill out this form if your provider or pharmacist has sent or will send a claim for you.
Fill out your reimbursement request
If your pharmacy or provider does not send the bill to PAN, you should:
- Pay the out-of-pocket cost for your medication or treatment.
- Download and complete the direct member reimbursement form.
If your expense is related to medication or supplies you got from your pharmacy, include:
- Itemized statement from your pharmacy, or
- Prescription label (must include patient name, date of service, treatment, or medication name, and patient responsibility/co-pay on the prescription label)
If your expense is related to medication or supplies you got at your provider’s office or a hospital, include:
- Explanation of Benefits (EOBs) from all applicable insurance companies
Submit your reimbursement request
Send the reimbursement form to PAN in one of these ways:
- Upload claims online: Patient portal **
- Mail to: PAN Foundation PO Box 2310 Mt. Clemens, MI 48046, or
- Fax to: 844-726-4728
**Note: if you’re submitting a claim via the portal, make sure all related claim documents are uploaded as a single document file. Uploading multiple files may result in delays and accidental denials.
After you submit a reimbursement
Checking the status of submitted claims
After we have your completed form, you should get a check within 10 business days. You can check the status of your reimbursement request in the PAN patient portal, or you can call us at 1-866-316-7263 Monday through Friday, 9 a.m. to 5:30 p.m. ET.
A claim may be returned if the submitted claim is illegible, or the claim is missing required information for processing.
For reconsideration, update the reimbursement form with the correct information and resubmit a legible claim for reprocessing. Make sure you write “corrected claim” on the resubmission.
Processed and denied claims
If your reimbursement request was processed and denied, check the claim denial reason.
If more information is required or you want the reimbursement request to be reconsidered, please update, and resubmit the form with the original documents along with the required information and write “corrected claim” for reprocessing. Make sure all documents are uploaded as a single document file.
If you need help with patient reimbursements, you can message us through your PAN portal, contact us online, or call us at 1-866-316-7263, Monday through Friday, 9:00 a.m. to 5:30 p.m. ET.