What is Crohn’s Disease?
When an individual has a chronic inflammatory condition of the gastrointestinal tract he or she may be diagnosed with Crohn’s disease. The disease was first described in 1932 by Dr. Burrill B. Crohn and is among a group of conditions known collectively as inflammatory bowel diseases (IBD) which affect as many as three million Americans. Both men and women are equally likely to be affected by Crohn’s disease which can occur at any age.
The age which Crohn’s disease is most often diagnosed is between 20 and 30 years. Many of those with an IBD disorder like Crohn’s disease have a first-degree relative who also has an IBD disorder. While Crohn’s disease has typically been more common among Caucasians, the incidence of the disease has increased among Hispanics and Asians over the past decade.
Crohn’s disease can affect any part of the GI tract from the anus to the mouth but is most common at the beginning of the colon and the end of the small bowel. While Crohn’s can affect the entire bowel wall, the inflammation can skip areas in between patches of the diseased intestine. Crohn’s disease is different from ulcerative colitis where only the innermost lining of the colon is affected, and there are no “skip” areas. There are several different types of Crohn’s disease, including:
- The most common type of Crohn’s affects the end of the small intestine and the large intestine (colon) and is known as Ileocolitis. Symptoms of Ileocolitis include significant weight loss, pain in the abdomen (middle or lower right), cramping, and diarrhea.
- Ileitis affects only the ileum and may have complications like fistulas or an inflammatory abscess in the right lower quadrant of the abdomen.
- Nausea, vomiting, loss of appetite, and weight loss often accompany gastroduodenal Crohn’s disease, affecting the stomach and the beginning of the small intestine.
- When an individual has patchy areas of inflammation in the upper half of the small intestine with mild to intense abdominal pain and cramps following meals, diarrhea, and fistulas, the type of Crohn’s disease is
- Crohn’s Granulomatous Colitis affects only the colon and has symptoms like rectal bleeding and diarrhea, skin lesions, joint pain, and abscesses, fistulas, and ulcers around the anus.
What Drugs are Typically Prescribed to Treat Crohn’s Disease?
There is no cure for Crohn’s disease and no single treatment that works for everyone. The primary goal is to reduce the inflammation that triggers Crohn’s symptoms and to limit complications. Anti-inflammatory drugs including corticosteroids (Entocort EC) can reduce inflammation but are generally used in Crohn’s patients only when they have not responded to other treatments. Oral 5-aminosalicylates like Azulfidine, Asacol HD, or Delzicol could be used to reduce inflammation brought on by Crohn’s but are generally considered to be of little benefit.
Immune system suppressors not only reduce inflammation, but also target the substances produced by the immune system in response to Crohn’s. Immune suppressors include Azasan, Imuran, Purinethol, and Trexall (methotrexate). Biologics may also be used to treat Crohn’s disease. Types of biologics include Tysabri, Entyvio, Remicade, Humira, Cimzia, and Stelara. Sometimes a combination of biologics is prescribed. Crohn’s patients may also be given antibiotics to help heal fistulas and abscesses, as well as anti-diarrhea medications, pain relievers, and vitamins and supplements to counteract the inability to absorb nutrients.
What Should You Do When Your Insurance Company Won’t Pay for Crohn’s Medication?
Medications used for Crohn’s disease can be expensive, therefore, many insurance companies balk at paying for these drugs, usually insisting that patients follow the step procedure. This means that you will be given a much less expensive drug (and potentially much less helpful) to try for up to 60 days. If the drug does not treat your symptoms or you have an adverse reaction to the drug, then your doctor might be allowed to “step up” to the next less expensive drug, and so on. If none of the lower-priced drugs work for your Crohn’s symptoms, then the insurance company might approve the original drug prescribed for you by your doctor.
You can appeal the decision of your insurer, although it can be a complex, lengthy process. You could also speak with attorney Scott Glovsky who fights insurance companies for people like you every single day. Scott is happiest when fighting for justice against big insurance firms that like to think they are untouchable. When you are at your lowest point after being denied a drug that could significantly improve your Crohn’s disease symptoms, Scott and his legal team can make a real difference in your life and your future. The Law Offices of Scott Glovsky wants you to know that you do not have to face this issue alone. We will fight for the outcome you need for your health and for the future of you and your loved ones.
Top Questions Regarding Crohn’s Disease Treatment
Is Crohn’s disease treatment covered by insurance?
It is estimated that those with Crohn’s disease may have triple the total healthcare costs, and double the out-of-pocket healthcare expenses as others without the disease. These costs include hospitalizations, visits to the ER, biologic, steroid, and opioid prescription drugs, as well as Crohn’s-related medical conditions like anemia. Since Crohn’s treatment can cost more than $30,000 per year to treat, this means you will be responsible for your percentage of the co-pay. Insurance does generally cover Crohn’s disease treatments but may not cover some of the more expensive drugs and treatments, deeming them “not medically necessary,” even when your doctor says they are. It can be an uphill battle to get your insurer to pay for treatments you need to deal with your Crohn’s disease—and one that benefits greatly from having a legal advocate in your corner like attorney Scott Glovsky.
How much does it cost to treat Crohn’s disease?
Those diagnosed with Crohn’s disease can expect to incur a minimum of $2,200 in out-of-pocket costs each year. Those who end up in the emergency room will have costs that are about twice as high as those who do not. Anemia can also add to the cost of Crohn’s disease. Prescription drugs can really change how much it could cost you to treat your Crohn’s disease. Each year and sometimes more often insurance companies change their formularies—the prescription drugs they will pay for. Further, many insurance companies balk at the $10,000-$30,000 per year that biologics cost. While your insurance plan may cover biologics at some level, you will usually have to get approval for the drug and will be required to pay a percentage of the cost. If coverage is denied, your attorney will need to file an appeal.
Getting Help from The Law Offices of Scott Glovsky When Your Insurance Won’t Pay for Crohn’s Medication
If your Crohn’s disease treatment is not approved or your insurance company won’t pay for Crohn’s medication, you need the level of help and experience that The Law Offices of Scott Glovsky provides. Attorney Scott Glovsky takes a limited number of cases, allowing him to devote the necessary time and care to each and every client. Scott gets to know his clients and their families because the best way to help them is to understand their issues. Each member of Scott’s firm works hard to do everything possible to help clients get the medical treatments and prescription drugs they need for their health.
With more than two decades of fighting insurance companies on behalf of his clients, Scott is personally involved in every case—when you hire The Law Offices of Scott Glovsky, you are hiring Scott Glovsky. While Scott has an amazing support team, he is the lead lawyer on every case. This is extremely beneficial for you, allowing Scott to negotiate with your insurance company or litigate when necessary. Attorney Scott Glovsky takes every case seriously because he fully understands that the outcome could affect his client’s life and future. Contact The Law Offices of Scott Glovsky today for a free case evaluation.