Heart Condition Treatment Insurance Denial Attorney
Receiving a heart condition insurance denial can be a shock. Then, once the shock wears off, you may quickly feel overwhelmed. After all, treatments for a heart condition are generally a necessity, rather than something that is optional. If your doctor has prescribed a specific heart condition treatment that is subsequently denied by your insurer, you need someone in your corner who will fight for you and for your rights. You need someone who is not afraid to go up against a big insurance company on your behalf. You need the Law Offices of Scott Glovsky.
Scott has been helping people in similar situations for a very long time. Early in his career, Scott worked in large corporate law firms defending insurance companies, therefore, he knows exactly how they think and how they operate. Scott takes fewer cases so he can personally devote the time and care necessary to each client. This is not an “assembly line” law firm that focuses on quick settlements—we focus on people and how insurance denials affect these people.
What Could Trigger a Heart Condition Insurance Denial?
Cardiovascular diseases like stroke, heart attack, clogged arteries, hypertension, amyloidosis of the heart, and abnormal heart rhythms can be expensive to treat in many cases, which can trigger a heart condition insurance denial. Amyloidosis is a disease that occurs when a protein builds up in the organs, preventing them from working properly.
The heart is one organ that can be adversely affected by amyloidosis. Insurance companies generally claim that a drug is experimental in order to avoid paying for the drug. Experimental treatments are not covered by many policies, even when those treatments have proven to be the best or the only solution to a medical problem. Insurers may deny a claim based on many different issues, including:
- Lack of prior authorization
- The treatment or drug is not medically necessary
- A coverage exclusion prevents the approval of the drug or treatment
- The treatment or drug is not approved because your heart condition was pre-existing
- The treatment or drug was incorrectly coded
- You failed to properly fill out all the paperwork related to the heart treatment or drug
What Should You Do if You Receive a Heart Condition Insurance Denial?
If you’ve received a heart condition insurance denial, there are steps you can take to help you get the treatment you need for your health—perhaps even for your very life. There is a process for filing an appeal with your insurance company. You will first file an internal appeal, following the process outlined by your specific insurer. If your internal appeal is unsuccessful, you are entitled to file an external appeal. Having a strong attorney by your side who will fight for you throughout the process can make it much easier for you to get the heart treatments you need and deserve.
What Insurance Companies Are Known to Deny Heart Condition Treatments?
Although any insurer may deny a claim, some insurance companies may be more likely to deny treatments they consider experimental. The Law Offices of Scott Glovsky successfully filed suit against Anthem Blue Cross of California DBA Anthem Blue Cross on behalf of a young girl in San Joaquin County in 2017. The girl was diagnosed with a heart irregularity for which her cardiologist prescribed a medically necessary heart monitor. The cardiologist appealed to Anthem, stating the girl could potentially have a fatal but treatable condition that could not be diagnosed without the implantable heart monitor. Anthem claimed lack of medical necessity until attorney Scott Glovsky went to bat for the young girl and the medically necessary heart monitor.
Some of the insurers who could potentially deny your heart condition treatment claim include may have Anthem Blue Cross, Blue Shield, Health Net, Kaiser, United Healthcare, Aetna, and others. Some denials are simple to correct. Perhaps you omitted required information or failed to completely fill out a form. These are easily correctable issues. In some cases, the insurer may have a valid reason to deny your claim. You may have chosen a provider that was not in-network or failed to obtain prior authorization. There are also many times when a heart condition insurance denial is not warranted and can benefit significantly from having a strong attorney like Scott Glovsky who will never back down from a large insurance company.
What Are Some Common Heart Condition Treatments?
There are many different heart condition treatments on the market. Some of these have been around for many, many years, while others are relatively new. It is worth noting that insurers rarely refuse to pay for a treatment—no matter how new it is—unless the treatment is expensive. In 2019, the FDA approved tafamidis, sold under the brand name Vyndamax.
The drug treats TTR amyloid cardiomyopathy but can cost as much as $225,000 per year. Some of the most common treatments for heart conditions include: angioplasty and stents, coronary artery bypass graft surgery, heart valve surgery, pacemakers, implantable cardioverter defibrillators, and heart condition drug treatments. Some of the most common drugs used for heart conditions include:
- Ramipril and other ACE inhibitors
- Angiotensin-II antagonists like losartan
- Beta-blockers like bisoprolol
- Anti-arrhythmic medicines like amiodarone
- Warfarin, and other anticoagulants
- Aspirin and other anti-platelet medicines
- Amlodipine and other calcium-channel blockers
Are Heart Condition Treatments and Heart Condition Drugs Expensive?
The average cost for common heart conditions are as follows:
- Angioplasty and stents–$35,000-$95,000
- Coronary artery bypass graft surgery—$150,000
- Heart valve surgery–$80,000-$200,000
- Pacemakers–$19,000-$96,000
- Implantable cardioverter defibrillators–$15,000–$33,000
How the Law Offices of Scott Glovsky Can Help Following a Heart Condition Insurance Denial
Choosing the Law Offices of Scott Glovsky following a heart condition insurance denial is the best step you can take for your health and for your future. Scott and his incredibly focused legal team take pride in the passion and integrity they bring to every case. Scott has a solid record of positive health and financial results for his clients while providing a high level of personal care and support for each and every client.
Scott Glovsky helps those who have been wronged by truly caring about each and every client by being responsive and always putting the client’s needs first. If you want an attorney who will be honest with you, always treating you with dignity and respect, speak to attorney Scott Glovsky for free. If results matter—then hire the Law Offices of Scott Glovsky.
