Increasingly employer-sponsored plans are including copay accumulators, copay maximizers, or alternative funding sources as part of their plan design. In fact, estimates suggest about half of all lives covered by commercial insurance are enrolled in a plan that utilizes a copay accumulator and/or a maximizer. 

If your team is responsible for guiding individuals through coverage options and understanding different plan designs, this is important to note because it could impact the out-of-pocket cost to your patient, and/or be the reason for denial of coverage. The knowledge a reimbursement or case manager needs to have to be effective at their role can be overwhelming to begin with, and adding this layer of complexity to collecting benefits data could unintentionally cause employees to make mistakes. 

That’s why we’re excited to share that Infinitus can automate complex call use cases regarding whether an accumulator and/or maximizer is in use for a plan or product. We’ve been doing it for years, and specifically, the Infinitus digital assistant can collect information regarding:

  • Whether a plan includes a copay accumulator or maximizer and if the payor’s plan allows the use of manufacturer copay assistance programs
  • If a copay assistance program accumulates toward a plan’s deductible and out of pocket max
  • Whether the full value of the manufacturer’s copayment program is applied evenly throughout the benefit year

With this information, Infinitus customers can confidently help patients identify and enroll in copay assistance programs and reduce the patient’s financial responsibility for specialty medications. See a real example of the Infinitus digital assistant collecting copay accumulator information from a payor here.

Why choose Infinitus for navigating copay accumulators and copay maximizers plan types?

Having learned from millions of calls across more than 1,000 medications and therapies, Infinitus understands the complexities of commercial and government insurance plan design. We can empower your team to:

  • Capture necessary data regarding copay accumulators and copay maximizers, as well as alternative funding sources or specialty carve-outs in the course of a normal benefits verification
  • Push back on payor agents if their answers do not meet customer expectations or general rules for alternative funding plan designs
  • Successfully navigate changing payor rules and requirements because our digital assistant is constantly learning from policies and prior calls.
  • Go further than eBV options, by collecting copay accumulator and maximizer data that can be hard to obtain electronically

To learn more, watch a demo of the Infinitus digital assistant collecting copay accumulator information, or reach out to our team today.