According to colorectalcancer.org, colon cancer is one of the most common types of cancer. It is expected that at least 152,810 people across the United States will be diagnosed with colon cancer in 2024, with 53,010 dying from the disease. The number of those diagnosed with colon cancer has steadily declined since the mid-1980s, thanks to an increase in colon screening, more colon cancer awareness, and lifestyle changes. Colon cancer is the fourth most common cancer in the United States, with one in 24 people receiving a colon cancer diagnosis during their lifetime. The average age of a colon cancer diagnosis is about 66. But because colorectal cancer rates have risen in individuals under the age of 50 in the past few decades, the American Cancer Society lowered its recommended screening age from 50 to 45.
If you or a loved one has been diagnosed with colon cancer, this is a very difficult time in your life. If you have also received a colon cancer insurance claim denial for a treatment or prescription drug your oncologist believes will help you, your challenges may be multiplied exponentially. Attorney Scott Glovsky can help you through this difficult time, working alongside you to ensure your insurance company pays for the treatments you need for your colon cancer diagnosis.
Overview of Colon Cancer Treatments
The following treatments are those most commonly recommended among those with colon cancer:
- Surgery—Surgery will depend on the stage and extent of colon cancer. Minimally invasive surgery, called laparoscopic surgery, removes polyps through incisions in the abdominal wall. More advanced surgery includes a partial colectomy if the cancer has grown into or through the colon, an ostomy procedure when healthy portions of the colon cannot be reconnected following a colectomy, lymph node removal when the colon cancer has spread, or removal of colon blockages.
- Chemotherapy uses strong medications to kill cancer cells and is often used in colon cancer patients after surgery when the cancer is large or has spread to the lymph nodes to kill any cancer cells left behind. In some cases, chemotherapy might be used before surgery to shrink a large cancer, making it easier to remove. Chemotherapy may be used on its own, or in conjunction with radiation.
- Radiation uses powerful energy beams that come from X-rays, protons, or other sources, to kill cancer cells. Radiation therapy can shrink a large cancer before an operation to make the cancer easier to remove.
- Targeted therapy uses medicines to attack specific cancer cell chemicals, causing those cancerous cells to die. Targeted therapy is often combined with chemotherapy and is common among those with advanced colon cancer.
- Immunotherapy treats colon cancer with medication that helps the immune system kill cancer cells. The body’s immune system is better able to fight off cancer by attacking cells (cancer cells) that should not be there. Immunotherapy is usually used only for advanced colon cancers. Keytruda is an immunotherapy treatment that works with the body’s immune system to fight colon cancer. Each dose of Keytruda—generally administered every six weeks—costs about $22,000.
- Genomic Tests—Oncology is becoming much more precise and targeted, including the treatment of colon cancer. Genomic tests can help oncologists efficiently and accurately determine the most effective treatment approach based on the genomic profile of the patient’s cancer.
How Do You Detect Colon Cancer?
Early detection of this this cancer could prevent over ninety percent of colon cancer deaths. The gold standard for colon cancer screening is a colonoscopy. And on July 26, 2024, the FDA approved the blood test Shield to detect the disease in adults 45 and older. Shield is highly effective. A clinical trial published in the New England Journal of Medicine found that Shield correctly detected this cancer in 83.1 percent of individuals confirmed to have colon cancer who were at an average risk and weren’t experiencing any symptoms.
Why Might You Receive a Colon Cancer Insurance Claim Denial?
Although your insurance company may “cloak” a colon cancer insurance claim denial behind words like “not medically necessary,” “investigative,” or “experimental,” at its core, those words usually mean that the treatment is expensive and the insurance company simply does not want to pay. If your doctor believes the treatment is medically necessary for your diagnosis of colon cancer, attorney Scott Glovsky will fight for the treatments you need, never hesitating to go up against a big company that doesn’t want to pay for necessary medical treatments. You should never give up following a denial by your insurer—Scott will be the advocate in your corner at a time when you desperately need someone who cares about you and your future.
What Should You Do if Your Colon Cancer Treatment Is Denied by Insurance?
If your insurer has denied a colon cancer treatment your doctor prescribed, it is normal that you are likely feeling discouraged and frustrated. You need to know that you do have options. You can file an internal appeal which essentially asks your insurer to take another look at the denial and change its decision. You may want to include a letter from your doctor with the internal appeal that details why you need the treatment in question. If your internal appeal is unsuccessful, you can file an external appeal with a neutral third party. The decision of this third party is legal and binding on your insurer. If the external appeal finds that your insurer should approve the treatment, then the insurer will have to do so. That said, we recommend speaking with an experienced health insurance denial attorney before you file the external appeal because your best path might be a legal one.
Which Insurance Companies Are Most Likely to Deny a Colon Cancer Treatment?
It is fairly common for insurers to deny immunotherapy treatments like Keytruda. The treatments are expensive, and it is easy for insurers to claim that Keytruda is experimental, investigational, or not medically necessary. The less money your insurance company pays for your treatments, the more profit the company makes. Because of this, all insurance policies include a coverage exclusion which limits coverage for any (expensive) treatment that the company may claim is not medically necessary. While any company can deny colon cancer treatment, the following are California insurers that could potentially deny your treatment.
- Anthem Blue Cross
- Blue Shield
- HealthNet
- Kaiser
- UnitedHealthcare
- Aetna
- and others
How the Law Offices of Scott Glovsky Can Help
Receiving a colon cancer insurance claim denial at a time when you are already feeling sick and vulnerable is a discouraging experience. When you choose the Law Offices of Scott Glovsky, we promise to fight for you with passion and commitment. We are relentlessly tough and relentlessly personal. This means we get to know each client personally, always treating them with respect. We take fewer cases so we can devote more time and energy to the cases we do take. Attorney Scott Glovsky has been helping people just like you since 1999, working with his highly experienced legal team to become a firm that is nationally recognized for its advocacy for the rights of insurance policyholders. When you choose the Law Offices of Scott Glovsky, we approach your case with the understanding that the outcome of this case could well impact the rest of your life and the lives of your family members. Contact the Law Offices of Scott Glovsky today—we seek full justice for every client.