If you have received an alopecia treatment insurance denial, you may be feeling hopeless and frustrated. When you have a medical condition like alopecia, and your doctor believes a specific treatment will benefit you, it can be beyond disappointing to receive a denial from your insurance company. After all, you have likely been faithfully paying your insurance premiums for many months or years, expecting that your insurer will return the favor if you ever need a specific treatment.
Many insurance companies prioritize one thing – their financial bottom line. In service of making millions (or billions) of dollars, many insurers deny any treatment that is costly by calling it “experimental,” “investigational,” or deeming it “not medically necessary.” If this is what you are facing, you need a strong legal advocate like attorney Scott Glovsky, who will fight for you every step of the way.
What is Alopecia?
Alopecia is an autoimmune disease that attacks the body’s hair follicles, resulting in patchy hair loss. While not all cases of alopecia respond to treatment, many will respond to medications and therapies that can help the hair regrow. Alopecia most commonly affects the hair on the scalp, manifesting in small, seemingly random areas of baldness.
Symptoms of alopecia include patches of hair loss on the scalp, facial hair, eyebrows, or body hair, and nail pitting. In some cases, alopecia can include itchiness, changes in skin color, black dots, white hairs, or short hairs that are thicker on top and narrower toward the scalp.
What Causes Alopecia?
In some cases, there are comorbidities associated with alopecia, including rheumatoid arthritis, inflammatory bowel disease, psoriasis, lupus, thyroid disease, atopic dermatitis, vitamin D deficiency, diabetes, allergic rhinitis, hyperlipidemia, and cardiovascular disease. While it is not entirely known what causes alopecia, those more likely to be diagnosed with alopecia include children, those with a family history of alopecia, and those with an autoimmune disorder, including diabetes, lupus, or thyroid disease.
Why Would Alopecia Treatment Be Denied?
The most common reasons for an insurance denial include an error in the paperwork or using an out-of-network provider. When treatment is expensive, your insurer may cloak a denial by using words like not medically necessary, investigational, or experimental. In the case of alopecia, an insurer may try to claim that the treatment is cosmetic rather than medically necessary. This can be particularly difficult for alopecia patients whose medical issue makes it virtually impossible to live a normal, healthy life since alopecia can cause stress, anxiety, and depression.
What Should You Do if Your Alopecia Treatment Is Denied?
If your alopecia treatment is denied, the fact that more than 40 percent of appeals are successful should give you hope. This number increases when a knowledgeable, aggressive attorney is involved. You should always appeal a denied medical treatment. You can first file an internal appeal, which asks your insurer to take another look at the denial and reverse its decision. If the alopecia treatment is still denied, you can file an external appeal with a neutral third party.
The results of this external appeal are binding on your insurer. (As such, we strongly recommend speaking with a qualified health insurance denial attorney before you do because this lawyer may recommend you take a different action.) You can submit a letter from your doctor with your internal and external appeals that clearly detail that the treatment is a medical necessity while disputing claims that it is experimental or investigational. Documentation is crucial when submitting appeals, including records of all communications with your insurer.
What Are Typical Treatments for Alopecia?
Treatments for alopecia may include one or more of the following:
- Corticosteroids, which are anti-inflammatory drugs that are either injected, taken orally, or applied topically. Side effects of corticosteroids can be serious, including mood changes, blurry vision, increased appetite, and weight gain.
- Phototherapy uses ultraviolet light and may include a drug called psoralen along with light therapy.
- Minoxidil is a topical drug that takes about 12 weeks of treatment before results are seen.
- Topical immunotherapy involves an allergen rubbed into the skin to deliberately create an allergic reaction that sometimes includes hair growth.
- Platelet-rich plasma removes blood from the patient’s body, processes it, and then injects it into the scalp to stimulate hair growth.
- Drugs like Olumiant and Litfulo, used off-label to treat alopecia.
Which Insurers Are Most Likely to Deny Alopecia Treatments?
Many insurance companies are not up to date on the latest FDA-approved treatments for conditions like alopecia. This means it can take many steps, including requesting prior authorization, trying less expensive treatments, and appealing a denial. While any insurer may deny alopecia treatment, the following California insurers could potentially issue a denial.
How Can the Law Offices of Scott Glovsky Help with An Alopecia Treatment Insurance Denial?
If your insurer is denying your claim for alopecia treatment, you need legal assistance. Attorney Scott Glovsky can help you file an internal and external appeal; if those are unsuccessful, he oftentimes will not hesitate to file a lawsuit against your insurer and demand that it pays for your treatment. This is not the time to give up – you paid your insurance premiums, and you deserve to have your legitimate healthcare claims paid. Contact the Law Offices of Scott Glovsky today.