Get the free 2014 Non Formulary Exception Fax Form - Coventry Medicare

NON-FORMULARY EXCEPTION REQUEST FORM PLEASE FAX COMPLETED FORM TO: (800) 639-9158 Patient Name: Member ID # Date of Request: DOB: Requesting Physician: DEA # Office Phone # Office Fax # MEDICATION

How to fill out 2014 non formulary exception

How to Fill Out 2014 Non Formulary Exception:

1. Gather necessary documents: Before starting the process of filling out the 2014 non-formulary exception, it's important to have all the required documents ready. These may include the prescription, medical records, and any supporting documents that explain why the non-formulary medication is necessary.
2. Contact the healthcare provider: Reach out to the healthcare provider who prescribed the non-formulary medication. Request them to provide a written statement explaining the medical necessity of the particular medication and why it is critical for your condition. This statement will be a crucial part of the exception request.
3. Obtain the non-formulary exception form: The next step is to acquire the non-formulary exception form for the year 2014. This can usually be obtained from your insurance provider's website or directly from their customer service department.
4. Fill out personal information: Start by filling out your personal information on the form, including your name, address, contact number, and insurance policy details. Ensure that all the information provided is accurate and up to date.
5. Provide details of the non-formulary medication: In a separate section of the form, provide details of the non-formulary medication for which you are requesting an exception. This may include the name of the medication, dosage, and frequency of use.
6. Attach supporting documentation: Attach all the necessary supporting documents along with the filled-out form. These may include the written statement from your healthcare provider, medical records, test results, or any other relevant documents that validate the medical necessity of the non-formulary medication.
7. Submit the form: Once the form is complete and all necessary documents are attached, submit it to your insurance provider. Most insurance companies have specific channels through which you can submit exception requests. It is important to follow their instructions and ensure that the form reaches the appropriate department.

Who Needs 2014 Non Formulary Exception:

1. Patients with specific medical conditions: The 2014 non-formulary exception is primarily required by patients who have specific medical conditions that require medications not present in the insurance provider's formulary. These patients may have tried other alternatives without success or have specific medical reasons that necessitate the use of a non-formulary medication.
2. Individuals with medications not covered by the formulary: Some individuals may find that the medication prescribed by their healthcare provider is not covered by the insurance provider's formulary for the year 2014. In such cases, they would need to request a non-formulary exception to ensure coverage for their essential medication.
3. Those who meet specific insurance criteria: Insurance companies often have specific criteria for granting non-formulary exceptions. Individuals who meet these criteria, such as having tried and failed alternative formulary medications, may be eligible for the exception.

Overall, the 2014 non-formulary exception is necessary for patients with specific medical conditions that require medications not covered by the insurance provider's formulary. By following the steps mentioned above and providing all the required documentation, individuals can increase their chances of receiving coverage for their non-formulary medication.

For pdfFiller’s FAQs

What is non formulary exception fax?

Non formulary exception fax is a request for approval to obtain a prescription medication that is not on the formulary list of a patient's insurance plan.

Who is required to file non formulary exception fax?

Healthcare providers or pharmacists are required to file non formulary exception fax on behalf of their patients.

How to fill out non formulary exception fax?

Non formulary exception fax usually requires information such as patient details, prescribing healthcare provider information, medication details, reason for non formulary request, and any supporting documentation.

What is the purpose of non formulary exception fax?

The purpose of non formulary exception fax is to request approval from the insurance plan to cover a medication that is not on their formulary list.

What information must be reported on non formulary exception fax?

Information such as patient demographics, healthcare provider information, medication name, strength, dosage, quantity, and rationale for the non formulary request must be reported on the fax.

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