Celgene Patient Support Specialist
Meet Joseph

Joseph is a Celgene Patient Support® Specialist. To meet your Specialist, click here.

PhoneFor more information, call 1-800-931-8691

Glossary

Appeal – A request to review an insurance company’s decision about why they are denying payment for a patient’s medication or procedure.

Appointment of Representative Form – This form allows a patient to appoint someone to act on their behalf during an appeals process with an insurer.

Claim – An application from a doctor’s office to a patient’s insurance plan to receive payment for services provided.

Co-insurance – This is the amount patients pay for their healthcare after they have met their deductible. The amount is based on a percentage of the cost of services or medication.

Co-payment – The flat dollar amount a patient pays out of pocket when visiting a doctor’s office, going to the emergency room, or picking up a prescription from a pharmacy.

Deductible – Amount that a patient pays each year, before insurance will begin to pay for the patient’s healthcare. Once a patient meets the deductible, the insurance begins to pay its share of the patient’s healthcare costs.

Denial – This is when an insurance plan refuses to pay for a medicine or service that a patient receives from a healthcare professional. This decision may be appealed.

Dual eligibility – A patient is qualified to receive both Medicare Part A and/or Part B services and also some form of Medicaid benefit.

Low-income subsidy (LIS) – Applies to Medicare Part D only. This is government aid given to low-income patients to help pay for the costs associated with Medicare Part D. Patients must apply to receive this aid.

Medicaid – This is a government insurance program. It helps patients with low income and resources. These programs differ by state.

Medicare – This is a government insurance program. Patients must be 65 years old or older or younger than 65 with certain disabilities or end-stage renal disease.

Open enrollment – The time of year when people can enroll in a health plan. It usually begins November 1 and ends January 31.

Out-of-pocket costs – Costs a patient pays out of their own pocket for healthcare. Costs include deductibles, co-payments, co-insurance, and any medical expenses that are not covered by insurance.

Premium – The amount you pay your insurance plan to have healthcare. Premiums are usually paid on a monthly basis.

Prior authorization/Precertification – Insurance companies need to approve some treatments before a patient can start them. Prior authorization and precertification can help determine if the insurance will pay for the patient’s medicine.

Reimbursement – The way an insurance plan pays a patient or healthcare professional for a product or service.

Restricted distribution program – Restricted distribution programs are mandated by the Food and Drug Administration (FDA) because of the risks associated with certain medications.

Special enrollment period – When people can enroll in a health plan outside of the open enrollment period due to certain life events. Life events include a change in family status, such as marriage or the birth of a child. Loss of other healthcare coverage is also considered a life event.

Underinsured – A person may have some healthcare coverage, but not enough to cover the cost of treatment.

Veterans coverage – Government-sponsored healthcare benefits available to veterans, dependents, survivors, and uniformed service members. It is run by the Department of Veterans Affairs.