Glossary

Update your billing and coding systems to include the permanent CYRAMZA® (ramucirumab) J-code: J9308, injection, ramucirumab, 5 mg. Issued by the Centers for Medicare & Medicaid Services (CMS), this permanent J-code is effective as of January 1, 2016.

Glossary

Understand the insurance terms you'll see or hear.

As you're providing information to your doctor's office and filling out your Lilly PatientOne application, here are some common terms that you may come across.

Appeal:

A request to overturn your insurance company’s decision to deny coverage for your prescribed medicine.

Benefits investigation (BI):

A review of your insurance plan to find out if a service or medication is covered and to find out if a prior authorization is needed to approve coverage.

Co-pay:

A fixed amount you pay for a doctor's visit, prescription medications, or other healthcare services at the time you receive them. Co-payments vary by insurance plan.

Coinsurance:

A fixed percentage you pay for healthcare services under your insurance plan. For example, after you reach your deductible, your plan may cover 80% of an approved cost, while you pay the remaining 20%. These percentages may vary by plan.

Commercial employer insurance:

An insurance plan provided by your employer. Usually the employer contributes a fixed amount to the plan, lowering your costs, or they may pay the costs entirely.

Deductible:

A fixed amount you pay for healthcare before your insurance begins to pay.

Denied claim:

Insurance plans may deny coverage for certain medications, tests, and procedures. You and your doctor can file an appeal if you are denied a claim through your insurance company.

Foundations:

Charitable groups that offer financial support for people who can't afford their co-pay or coinsurance, or people who have no insurance.

Lilly Cares Foundation:

An independent nonprofit organization that provides prescribed Lilly Oncology medications at no cost for qualified people who have been denied coverage or who have no health insurance at all.

Medicaid:

A combined state and federal government program that helps cover medical costs for some people who have low incomes. These programs vary by state.

Medicare:

Federal health insurance for people who are 65 and older or younger people with certain disabilities. End-stage kidney failure is also covered by Medicare. There are various Medicare plans, including Medicare Part A for hospital insurance; Part B for medical insurance; Part C, which may be used to replace Parts A, B, and possibly D; and Medicare Part D, which covers prescription medications.

Out-of-pocket expenses:

The costs you pay when your insurance doesn't fully cover your healthcare services. These can include deductibles, co-pays, or coinsurance.

Prior authorization (PA):

Before some insurance companies will pay for a service or medication, it must be preapproved. If needed, you and your doctor's office will submit the request for this authorization based on the requirements of your insurance company.

Private insurance:

Healthcare plans that are offered through private companies and usually paid for by individuals.

Protected Health Information (PHI):

Information about your health that is protected by law and cannot be released to third-party organizations without your signed written consent.

Reimbursement assistance:

A Lilly PatientOne service that provides information to help your doctor's office verify your insurance coverage, submit prior-authorization requests, and navigate the appeals process for denied claims.