OmidriAssure "We Pay the Difference" Commercial Reimbursement Program - Non-covered benefit

Funded
About
The OmidriAssure "We Pay the Difference" Commercial Reimbursement Program - Non-covered benefit is designed to provide financial assistance to patients using Omidria who have commercial insurance. This program ensures that eligible patients receive support for their surgical treatments even if they have not met their commercial deductible obligations. With no income eligibility requirements, OmidriAssure enhances access to Omidria by covering the difference in costs not paid by insurance.
Insurance requirements: Commercially insured
Enrollment Forms
Enrollment Form
Program Requirements
•Valid only for residents in the US and Puerto Rico
•Enrollment Required: Yes
•Coverage Required: No
•Needs Based: No
•Activation Required: No
Program Details
•Program provides financial assistance for patients with insufficient payment for commercial insurance only
•The benefits apply even if the annual commercial deductible obligation has not yet been met
•No income eligibility requirement
•After a primary commercial claim is processed for a patient with only commercial insurance, complete the We Pay the Difference submission form including patient name, date of birth, date of surgery, and physician name for every commercial claim for which the facility is seeking assistance
•Provide a clear, legible copy of the explanation of benefits (EOB) for every patient
•Facility faxes the We Pay the Difference submission form(s) and all of the EOBs to OMIDRIAssure at 18556643741
•HCP may enroll patients online and submit claims also at: https://www.omidriassure.com/