Marianne Martinez
The PAN Foundation offers grants to cover out-of-pocket medication costs, health insurance premiums, and transportation expenses. The grants are available to patients with active grants that cover deductibles, co-payments, and coinsurance costs related to eligible medications or supplies. To file a claim with a PAN Foundation grant, you can submit claims electronically or through your billing software. If your pharmacy or provider does not send the bill to PAN, you can pay the out-of-pocket cost for your medication or treatment, download the direct member reimbursement form, and send the form to PAN by mail or fax. You can also call the PAN Foundation at 1-866-316-7263, Monday through Friday, 9:00 a.m. to 5:30 p.m. ET, for assistance with claims, billing, or reimbursement.
| Characteristics | Values |
|---|---|
| Who can apply for a PAN grant? | Patients, caregivers, providers, or pharmacies can apply for a PAN grant. Healthcare providers and pharmacies can apply on behalf of their patients. |
| How to apply for a PAN grant | You can apply for a PAN grant online through the PAN portal or by calling 1-866-316-7263, Monday through Friday, 9:00 a.m. to 5:30 p.m. ET. |
| What is covered by a PAN grant? | PAN grants cover out-of-pocket medication costs, health insurance premiums, and transportation expenses. This includes prescription medications, generic or bioequivalent drugs, and transportation to and from activities that improve overall health. |
| How long does a PAN grant last? | PAN grants provide funding for 12 months, called the eligibility period. You can apply for additional funding or renewal if your funds run out or your eligibility period is ending/has ended. |
| How often must claims be submitted? | Claims or reimbursements must be submitted every 120 days during the enrollment period to keep the grant active. |
| What is the process for submitting claims? | Claims can be submitted electronically through billing software or by mail/fax if a direct member reimbursement form is used. Electronic claims are processed within five business days. |
| What are the requirements for keeping a PAN grant active? | To keep the grant active, patients or their representatives must request and receive payment for a claim from PAN every 120 days. If a claim is not submitted and paid within this timeframe, the grant will be canceled. |
| What if a medication is not covered by the patient's grant? | You can submit an online request or call to request new medication coverage. However, new medication coverage cannot be guaranteed. |
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What You'll Learn
How to submit a claim
To submit a claim with the PAN Foundation, you must first ensure that you meet the eligibility criteria. The PAN Foundation offers grants to cover out-of-pocket medication costs, health insurance premiums, and transportation expenses.
If you are a patient or caregiver, you can give your PAN benefit card and grant welcome letter to your provider or pharmacy. They can then submit any claim or reimbursement for you, and they will be paid directly by PAN. You can use your grant at different pharmacies or with other providers, and you can choose which covered medications to use your grant on. You, your provider, or your pharmacy must submit a claim or reimbursement every 120 days during your enrollment period to keep your grant active. If you have a $0 balance but still need money for medication, you can apply for additional funding.
If your pharmacy or provider does not send the bill to PAN, you must first pay the out-of-pocket cost for your medication or treatment. You can then download the direct member reimbursement form and send it to PAN by mail or fax. You should receive a check within 25-30 days. You can also submit claims online via your billing software, which is the fastest way to submit a claim. You must include the following information:
- Completed CMS-1500, UB-92, or UB-04 form
- Corresponding itemized Explanation of Benefits (EOB) or Medicare Remittance Advice (RA) showing payment by the insurance
- For Diagnosis-Related Group (DRG) claims, the billing code/type on the claim form and the EOB must indicate DRG
- For APC claims, ensure the EOB is itemized
You can also contact the PAN Foundation by phone or through your PAN portal account for any inquiries or further assistance.
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Understanding eligibility
Firstly, it is important to note that PAN Foundation grants are designed for patients with active grants that cover deductibles, copayments, and coinsurance costs related to eligible medications or supplies. All patients must be insured, and their insurance must cover the medication or treatment for which they are seeking assistance. The medication or treatment must also be listed as a covered medication for their specific disease fund. PAN covers products that are FDA-approved or listed in official compendia or evidence-based guidelines for the particular disease fund.
Secondly, the PAN Foundation offers different types of grants, including copay grants, health insurance premium grants, and transportation grants. Each grant has specific eligibility requirements. For instance, copay grants cover out-of-pocket costs for medications listed in the disease fund formularies, and patients can choose their pharmacies, providers, and medications within their treatment plan. Health insurance premium grants, on the other hand, help pay for insurance premiums for patients undergoing treatment for various diseases, and the grant amounts and eligibility criteria vary by disease fund. Transportation grants assist with transportation costs to and from activities that improve the patient's overall health.
Additionally, eligibility for PAN Foundation grants is typically valid for a 12-month period, known as the eligibility period. During this time, it is mandatory to submit a claim or reimbursement request every 120 days to keep the grant active. If a claim is not submitted within this timeframe, the grant may be canceled. It is important to note that grant amounts and eligibility requirements can differ based on the specific disease fund, and applicants can use the pre-screening tool on the PAN Foundation's website to assess their eligibility.
Lastly, providers and pharmacies play a crucial role in the grant application and management process. They can apply for grants on behalf of their patients and help them navigate waitlists and manage claims and billing. This includes submitting claims for reimbursement and ensuring that the patient's insurance covers their medication or treatment. By working closely with providers and pharmacies, applicants can better understand their eligibility for PAN Foundation grants and effectively utilize the grants to cover their healthcare expenses.
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What's covered by the grant
The PAN Foundation offers grants to help cover out-of-pocket medication costs, health insurance premiums, and transportation expenses for patients with more than 80 diseases and chronic illnesses. The grants cover deductibles, copayments, and coinsurance costs related to eligible medications or supplies. PAN covers products that are FDA-approved or listed in official compendia or evidence-based guidelines for the specific disease fund. This includes all prescription medications in the disease fund formulary.
Certain disease funds also cover medical supplies for administering treatments, preventative vaccines, and health insurance premium assistance. PAN is the payer of last resort, so all patients must be insured, and the patient's insurance must cover their medication. The patient's medication or product must be listed as a covered medication for their disease fund.
The PAN grant funds are yours to manage, and you can choose when and where you use them for your covered medications, regardless of which healthcare professionals are managing your treatment. You can use your grant funds right away and keep them active by requesting and receiving payment for a claim from PAN every 120 days. You can submit claims throughout your 12-month eligibility period and for 60 days after it ends.
You can apply for additional funding if your initial grant funds run out or apply for a renewal grant when your initial grant period is ending or has ended.
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How to check the status of a claim
To check the status of a claim, you can log in to your PAN portal account online 24/7. If you need further assistance, you can call the PAN Foundation at 1-866-316-7263, Monday through Friday, 9:00 a.m. to 5:30 p.m. ET.
Before submitting a claim, it is important to verify the patient's grant balance using your PAN portal account. The PAN Foundation contracts with Luminare Health (formerly Trustmark) to process medical claims and with SS&C Health to process pharmacy claims.
If your pharmacy or provider does not send the bill to PAN, you can pay the out-of-pocket cost for your medication or treatment, download the direct member reimbursement form, and send the form to PAN by mail or fax. After submitting the completed form, you should receive a check within 25-30 days. You can always call to check the status of your reimbursement request.
For electronic claims, providers can submit claims directly via their billing software, and these are typically processed within five business days. For paper claims, each date of service needs its own claim form and EOB/RA. Provider payments are sent by ECHO Health, PAN's third-party healthcare payment vendor, through methods such as QuicRemit virtual credit cards, ACH transfers, or paper checks.
It is important to note that for copay grants, a claim or reimbursement must be submitted every 120 days during the enrollment period to keep the grant active. If you have a transportation grant, you must use your prepaid debit card for an eligible expense at least once during this 120-day period.
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How to receive payments
To receive payments from a PAN Foundation grant, you must first ensure that you are an active grant recipient. PAN Foundation grants provide funding for 12 months, after which you can apply for additional funding or a renewal grant.
There are various types of PAN grants, including copay grants, health insurance premium grants, and transportation grants. To receive payments, you must understand what your grant covers and where you can use the funds. PAN grants can be used to pay for out-of-pocket medication costs, health insurance premiums, and transportation expenses related to your overall health.
You can use your PAN grant funds right away after approval. You have the flexibility to choose when and where to use the grant for eligible covered expenses. You can use your grant funds with any provider or pharmacy of your choice. To use your grant, simply provide your PAN member ID and letter to the provider or pharmacy.
To receive payments, you can use a transportation debit card, which can be swiped as a credit card option without any transaction fees. You can also access your grant funds through your PAN portal account online, which is available 24/7. Additionally, you can contact the PAN Foundation by calling their customer service line during business hours to inquire about receiving payments.
It is important to note that to keep your grant active, you must submit a claim or reimbursement every 120 days during your enrollment period. If a claim is not submitted within this timeframe, the grant will be canceled. You can submit claims electronically or through the mail, and payments will be sent by PAN's third-party healthcare payment vendor.
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Frequently asked questions
You can submit claims for patients with active grants that cover deductibles, copayments, and coinsurance costs related to eligible medications or supplies. If you are a patient or caregiver, give your PAN benefit card and grant welcome letter to your provider or pharmacy. They can submit any claim or reimbursement for you, and PAN will pay them directly.
The PAN Foundation’s grant use policy requires patients, or their healthcare professional, to request and receive payment for a claim from the PAN Foundation every 120 days to keep the grant active.
Pay the out-of-pocket cost for your medication or treatment. Download the direct member reimbursement form. Send the form to PAN by mail or by fax. After we get your completed form, you should get a check within 25-30 days.
