If you are battling cancer, you have enough things to worry about in your life other than an insurance denial for a treatment your doctor believes is best for you. Guardant 360®, a liquid biopsy diagnostic tool, gained FDA approval in 2020, using next-generation sequencing technology to quickly and accurately identify patients with specific mutations that indicate many types of cancer.
Guardant 360 combines two technologies—NGS and liquid biopsy in one diagnostic test that can then guide treatment decisions. If you have received a Guardant 360 insurance denial you may feel frustrated, angry, and helpless to change the denial into an approval. Attorney Scott Glovsky fully understands these feelings, and he is ready to fight for you following a Guardant 360 insurance denial.
What is Guardant 360 and What Is It Used For?
Guardant 360 benefits patients through its much less invasive testing procedure. Rather than requiring a tissue biopsy via a needle and surgical procedure, Guardant 360 is a liquid biopsy that uses a blood sample from cancer patients who are in an advanced state of cancer. Patients receive a “mapping” of multiple biomarkers of genomic alterations, rather than one biomarker at a time. This results in decreased waiting times for appropriate treatments while providing insight into potential resistance mechanisms.
Guardant 360 allows those with more advanced cancers to receive targeted therapies and drugs as early as possible in the process. Guardant 360 can be used for all types of solid tumors but cannot be used for hematological tumors like leukemia. This test is 1000 times more specific than other sequencing techniques, ending the days when tumor tissue had to be removed through surgery or biopsy.
Why Claims Associated with Guardant 360 May Be Denied
Claims are often denied because the paperwork was incorrectly filled out, the coding was incorrect, there was no prior authorization, or the insurance policy specifically excludes the treatment. In some cases, these issues can be fixed, while in others—like specific exclusions—they may not be able to be fixed. If, however, your insurance company issued a Guardant 360 insurance denial based on “no medical necessity,” “experimental,” or “investigational,” attorney Scott Glovsky may be able to help.
The issue in most of these denials comes down to money. Insurance companies are often much more interested in their financial bottom line than in the people they insure. Guardant 360 can cost up to $5,000 per test, and many insurance companies simply don’t want to pay for it, so may use any excuse to issue a denial.
What Can You Do About a Guardant 360 Insurance Denial?
Unfortunately, insurance companies get away with denying claims because many people don’t realize they can appeal such a decision. Even those who know they can appeal may not have the time or the know-how to do so. This is a time when you need a strong legal advocate by your side. You need an attorney who never backs down from a fight no matter how big the insurance company is. Scott Glovsky is that attorney.
Scott can help you file an internal appeal that asks your insurance company to reconsider the denial. You may need a letter from your doctor to help persuade the insurance company to reverse its decision. If your internal appeal is unsuccessful, Scott and his legal team can help you take the next step and file an external appeal or take legal action. During an external appeal, a neutral third party will look at the facts and make a decision, which is binding on the insurance company.
Specific Insurance Companies That Are Known to Deny Guardant 360
Virtually any insurer can issue a Guardant 360 insurance denial, however, some insurance companies are more likely to do so. In 2022, non-specific language in Governor Newsom’s veto of a bill aimed specifically at mandating automatic insurance coverage of biomarker tests caused some confusion. While most health insurance companies in California will cover biomarker testing like Guardant 360 when it is medically indicated and backed up with supporting evidence, some of the following companies might not.
How Can a Guardant 360 Insurance Denial Affect My Life?
Tissue biopsies are considered at least somewhat invasive, and Guardant 360 can help avoid these invasive procedures—including surgeries—as the first FDA-approved comprehensive liquid biopsy for all advanced solid tumors that delivers results in as little as seven days. If you have been battling cancer for a significant length of time, undergoing one more procedure can seem like a bridge too far. With Guardant 360, you can avoid a biopsy yet receive results that allow your physician to make treatment choices quickly and accurately.
How the Law Offices of Scott Glovsky Can Help with a Guardant 360 Insurance Denial
If you have received a Guardant 360 insurance denial, don’t wait. Attorney Scott Glovsky and his experienced legal team at the Law Offices of Scott Glovsky are ready to help you through this difficult time. When you have spent years paying your health insurance premiums only to receive a claim denial, it can be not only discouraging but also potentially damaging to your health. Like most people, you may have no idea where to start or how to proceed when fighting an insurance claim denial. This is a difficult journey that you may simply not feel up to. Having a nationally recognized advocate in your corner like Scott Glovsky can take the burden from your shoulders, allowing you to concentrate on your health and your future. Contact the Law Offices of Scott Glovsky today for help you can count on.