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Unfortunately, the average lifespan of a patient diagnosed with Amyotrophic Lateral Sclerosis is only two to five years. So when you or someone you love receive an ALS insurance denial, you know that time is of the essence. It is critical to get the denial reversed quickly so you can get the treatments you need to help slow the progression of the disease and boost your quality of life.
Having a passionate, well-respected, and successful insurance lawyer as your advocate can make a big difference. Attorney Scott Glovsky and his legal team have been fighting for insurance policyholders against large corporate insurance companies for over twenty years and can help ensure you get the treatments your life depends on.
What is ALS (Amyotrophic Lateral Sclerosis), AKA Lou Gehrig’s Disease?
Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is an uncurable progressive neurodegenerative disease that impacts nerve cells in a person’s spinal cord and brain. With this disorder, motor neurons that control voluntary muscles progressively degenerate. This deterioration leads to atrophy and muscle weakness. ALS eventually results in the loss of the ability to initiate and control muscle movement. This means the patient can lose the ability to eat, move, speak and breathe. Once diagnosed with Lou Gehrig’s disease, a person typically survives two to five years on average. For this reason, treatments are essential to help a patient’s quality of life.
Is Lou Gehrig’s Disease a Genetic Disease?
In ninety percent of cases, people don’t have a genetic mutation or a family history of ALS. But in five to ten percent of cases, people do have ALS in their families. These cases are referred to as “familial ALS.” And with familial ALS, there is a fifty percent chance that descendants will inherit the gene mutation that can lead to ALS.
How Do Practitioners Treat ALS?
Patients typically have comprehensive care plans and multidisciplinary healthcare teams to provide holistic support and help manage this non-curable disease. Practitioners often include physicians, physical therapists, occupational therapists, speech therapists, nutritionists, and psychological counselors. There are both invasive and non-invasive ALS treatments.
What are ALS Medications?
As of December 2023, there are seven FDA-approved ALS treatments. These include Radicava, Qalsody, Rilutek, Tiglutik, Nuedexta, and Excservan. Amylyz Pharmaceuticals pulled its medication Relyvrio from the market on April 4, 2024 after its poor performance in a late-stage clinical trial. Amylyz will provide Relyvrio for free to patients already taking the medication. Medications can slow the progression of the disease and the decline in functioning, thus improving life expectancy.
What are Non-Invasive ALS Treatments?
Because ALS impacts one’s ability to breathe, eat, move, and speak, non-invasive ALS treatments focus on managing symptoms and improving a patient’s quality of life.
What is Non-Invasive Ventilation or a Non-Invasive Ventilator?
Non-invasive ventilation or a non-invasive ventilator (NIV), also known as a complex home breathing machine or a complex breathing machine, helps patients in later stages of ALS whose weaker respiratory muscles have led to difficulty breathing. NIV improves respiratory function and helps prevent respiratory failure by assisting to maintain oxygen levels and remove carbon dioxide. Ultimately, a NIV or complex home breathing machine helps patients maintain more independence and functionality.
NIV includes devices like BiPAP® (Bilevel Positive Airway Pressure) machines. Bi suggests two distinct pressures and PAP stands for “positive airway pressure.” BiPAP or BPAP machines help normalize breathing because they push pressurized air into a person’s lungs via a hose and face mask. Their bilevel design supports two separate levels of air pressure – one for inhaling and one for exhaling. The pressure for breathing in, called “inspiratory positive airway pressure” (IPAP), is higher than the pressure for breathing out, known as “expiratory positive airway pressure (EPAP). Pressurized air helps prevent tissue surrounding the upper airway from collapsing and obstructing a person’s airway. If a person’s breathing is very shallow, the BiPAP device can be programmed to push air in consistent intervals.
What Are Other Non-Invasive Treatments?
- Physical Therapy can help a person with flexibility and even pain in some cases. Exercises including stretching can help sustain cardiovascular health, range of motion and muscle strength, delaying muscle atrophy and improving overall mobility. Sometimes patients use non-invasive devices including braces, canes, walkers and wheelchairs to help with mobility.
- Speech Therapy can aid with speech and swallowing. Non-invasive augmentative and alternative communication (AAC) devices like an alphabet board, pen and paper, and a smart phone app such as text-to-speak help a patient better communicate. Speech therapists help address swallowing issues to prevent issues such as aspiration and pneumonia.
- Occupational Therapy can help a person with daily activities including eating, bathing, grooming and dressing.
- Nutritional Support provides eating adjustments to address problems linked to swallowing difficulties.
- Psychological Support including support groups and individual counseling help patients deal with the emotional aspects of ALS.
- Palliative Care focuses on a person’s pain and discomfort.
Why Might You Receive an ALS Insurance Denial?
Your ALS insurance denial might stem from a correctable error or a more serious issue. The health insurance company might have rejected your claim, potentially calling the treatment is experimental or investigational. Of course, this term often implies the specific treatment has a high cost. If your doctor recommends a specific treatment, it’s because he or she believes it could benefit you. Facing denial after such a recommendation can be incredibly frustrating and even scary. In such challenging situations, Scott Glovsky can help. Scott specializes in assisting individuals navigating similar circumstances. He has years of experience, empathy, and a deep understanding of how major insurance firms operate (he used to work on the other side). Scott has spent his career helping policyholders in difficult situations like this.
What Can You Do if Your ALS Insurance Claim is Denied?
If your claim denial is the result of a simple mistake, you and/or your doctor can fix the mistake. But if your denial stems from a more serious issue, you need an experienced health insurance attorney who understands how insurance companies operate and can advocate for you. Of course with any denial, you start with an internal appeal. If your appeal is unsuccessful, then your attorney may recommend either filing an external appeal or perhaps taking legal action. This decision is partially based on your specific situation, and partially based on whether your health insurance policy is an ERISA or non-ERISA policy.
Which Insurance Companies are Most Likely to Deny Your ALS Claim?
While any health insurer may deny your ALS insurance claim, some insurance companies are more likely to do so. Californians may have Kaiser, Health Net, Aetna, Anthem Blue Cross, Blue Shield, United Healthcare, or another insurer. Attorney Scott Glovsky has fought against all these insurance companies with positive results.
How We Can Help After an ALS Insurance Denial
If you’ve received an ALS insurance claim denial, contact attorney Scott Glovsky quickly. When you select the Law Offices of Scott Glovsky, you can be sure you’ll have someone in your corner who really cares about your outcome and who will forcefully challenge your insurance company with the goal of having it pay for your medically necessary treatment. Scott and his team care – they want to ensure that insurers honor the commitment they made to you. We understand that you may be feeling hopeless and beaten by the system. We’ll listen to you and then determine the best course of action. We believe in our clients, and handle every case in a professional and personal manner. Contact the Law Offices of Scott Glovsky now for a free case evaluation.