If you are living with a gastrointestinal disorder, you may have tried many different treatments, drugs, and perhaps even surgical procedures. Unfortunately, a gastrointestinal disorder can adversely affect other parts of your body, as well as force you to change the way you live your life to accommodate your disorder. A GI condition can potentially affect your respiratory health and even your joints, skin, and eyes. What if your doctor prescribes a treatment that has the potential to significantly improve your life by improving your health and your future—then your insurer denies the treatment?
Obviously, this can be a severe blow. You’ve faithfully paid your monthly health insurance premiums for months or years, yet now when you need something from your insurer, it is putting financial gain over your health. You don’t need to simply accept a gastrointestinal disorder treatment denial. Attorney Scott Glovsky and his dedicated legal team help people just like you every single day.
When you speak to the Law Offices of Scott Glovsky, you will immediately know that we are different from other law firms. That difference lies in the fact that we truly care about each and every person who walks through our doors. We understand what you’re going through, and we are wholly dedicated to fighting for you, never giving up, and never backing down.
What Are the Reasons for a Gastrointestinal Disorder Treatment to be Denied by Insurance?
There are many different reasons you could have your gastrointestinal disorder treatment denied by insurance. Some of those reasons are simple ones, with simple solutions, while others may be much more complex. First, it is helpful to understand that there is a difference between a “rejected” claim and a “denied” claim. A rejected claim has a problem that must be corrected, then the claim is resubmitted. A denied claim cannot simply be resubmitted because the payment determination has been made, but it can be appealed.
Some of the most common reasons for a treatment denial are insufficient information, duplicate billing, improper coding, the claim being filed too late, the specific service is not covered, prior authorization for the procedure was not obtained, or your practitioner is considered “out of network.” Most of these issues can be fairly easily corrected. While you still have to appeal the decision, there are relatively simple steps you can take to correct the error and have the denial reversed.
If, however, your insurer denies your gastrointestinal disorder treatment because it is “not medically necessary,” or because the treatment is “experimental,” or “investigational,” then the process can be much more intense. These types of denials can benefit significantly from having attorney Scott Glovsky by your side, working hard to convince the insurer that it should reverse its decision.
What Should You Do if Your Health Claim is Denied?
If you have a gastrointestinal disorder treatment denied by insurance, your insurer must provide you with a written explanation as to why the claim was denied. Review your coverage and summary of benefits to determine whether your insurer has a valid reason for denying your treatment. If you don’t believe the denial was legitimate, your first step might be to talk to your doctor and ask him or her to speak to the insurer to explain why the treatment is necessary. If the denial is not reversed after this, you have the right to file an internal appeal with your insurer.
You will probably need to resubmit your claim, along with the explanation of benefits denying your claim and a letter from your doctor explaining why the treatment, procedure, or medication is medically necessary or is not considered experimental or investigational. Supporting documentation such as test results or medical records can be included with your information. If the treatment is considered urgent, your insurer must provide you with a decision within 72 hours.
If the treatment has not yet been received, you must receive a decision within 30 days, and if you have already received treatment, you must receive a response within 60 days. If you receive another denial for your gastrointestinal disorder treatment, you can file an external appeal where an independent review organization will review your claim and make a final decision. While this process can sound overwhelming, the Law Offices of Scott Glovsky can help you through the entire process, fighting for you and your right to appropriate medical care.
Are Some Insurers More Likely to Deny Your Gastrointestinal Disorder Treatment?
While any insurer can deny a claim, some insurers are more likely to do so than others. Californians typically deal with Anthem Blue Cross, Blue Shield, Cigna, Health Net, Kaiser, UnitedHealthcare, Aetna, and others. Attorney Scott Glovsky has gone up against all these companies and never hesitates to do so. He will gladly be your advocate from start to finish, never backing away no matter how difficult the fight may seem.
What Are the Most Common Gastrointestinal Disorders?
There are many different gastrointestinal diseases including the following:
- Peptic ulcer disease
- Barrett’s esophagus
- Abdominal adhesions
- Crohn’s disease
- Celiac disease
- Short bowel syndrome
- Whipple’s disease
- Zollinger-Ellison syndrome
- Malabsorption syndrome
- Ulcerative Colitis
What Are the Newest Drugs and Treatments for Gastrointestinal Disorders?
Depending on the type of gastrointestinal disorder, along with your age and general health, your treatment could include a surgical procedure, lifestyle changes including a strict diet, or newer medications developed for gastrointestinal disorders. Some of those medications include:
- Selective NK1 Receptor Antagonists like Tradipitant to treat gastroparesis (delayed gastric emptying that slows or stops the movement of food from the stomach to the small intestine), and may be able to treat motion sickness and vertigo as well.
- Ghrelin Receptor Agonists like Relamorelin to accelerate gastric emptying, thus treating gastroparesis.
- Visceral Analgesics are used to manage moderate to severe acute gastrointestinal pain among adults for whom alternative treatments have failed.
- Cannabinoid Type 2 Receptor Agonist to treat Crohn’s disease
- Modulating bile acid transport inhibitors like Elobixibat for those with IBS
How an Experienced Attorney from the Law Offices of Scott Glovsky Can Help
If you have a gastrointestinal disorder treatment denied by insurance, attorney Scott Glovsky can help. Scott is well respected, with a solid reputation and his prior work in large corporate law firms defending insurance companies allows him to fully understand how they think and operate. Because of this, Scott always stays one step ahead of these large insurers. Scott and his team take fewer cases so they can personally devote the necessary time to each and every client, allowing them to know the entire story behind the client’s suffering related to an unjust insurance denial. Attorney Scott Glovsky brings passion and integrity to each case and has a solid record of positive results. Contact the Law Offices of Scott Glovsky today.