It can be disheartening to be diagnosed with hypertension, particularly when you are young, or have few risk factors. A diagnosis of hypertension is rarely made based on a single blood pressure reading unless that reading is dangerously high. A blood pressure reading measures the pressure in the arteries when the heart beats and between heartbeats.
The top number, called systolic pressure, is the pressure when the heart beats, and the bottom number, called diastolic pressure, is the pressure between heartbeats. Stage 1 hypertension is usually diagnosed when the top number is consistently between 130 and 139 and the bottom number is consistently between 80 and 89. Stage 2 hypertension involves a top number that is consistently higher than 140 and a bottom number consistently higher than 90.
If you or a loved one has recently received a diagnosis of hypertension and your doctor is recommending additional tests and treatment that your insurer has denied, it can be frightening to think that your untreated hypertension could cause more serious health issues, even including a stroke. Having an experienced insurance denial attorney like Scott Glovsky in your corner can help ensure a positive outcome.
What Types of Illnesses and Medical Conditions Can Cause Hypertension?
Some of the risk factors for hypertension can be avoided, while others cannot. The most common risk factors for hypertension include:
- An unhealthy diet, including too much alcohol or caffeine, and too little activity
- Age, race, ethnicity, gender, and family history
- Pregnancy
- Obesity
- Sleep apnea
- Diabetes
- Medications like some antidepressants, decongestants, hormonal birth control pills, and NSAIDs like aspirin or ibuprofen
- Kidney disease
- Metabolic syndrome
- High Cholesterol
- Thyroid issues
Tests to determine whether you have hypertension include ambulatory blood pressure monitoring, blood and urine tests (to check for blood sugar, cholesterol, kidney function, liver function, and thyroid function), an ECG or EKG, and an echocardiogram.
What Are Some of the Reasons for a Hypertension Treatment Insurance Denial?
While your hypertension may be mild and require nothing more than a blood pressure medication, if your hypertension is due, at least in part, to obesity, your doctor may prescribe a treatment option like Mounjaro/Zepbound, Saxenda, Wegovy, or Ozempic to help you lose some weight and protect your heart. These drugs, because of their cost, are often denied by insurers. “Regular” hypertension drugs can cost between $300 and $600 per year, while drugs like Mounjaro, Saxenda, Wegovy, and Ozempic can cost from $1,300 to $2,000 per month.
Insurers will usually deny the weight loss drugs unless you have been diagnosed with Type II diabetes, or your doctor can show that you have tried other hypertension drugs and they did not work well – and that losing weight will lower your blood pressure. Some insurers may also label these drugs “not medically necessary,” “experimental,” or “investigational” as a means of denying the treatment. In the end, many insurance denials are often due to cost.
What Should You Do if You Receive a Hypertension Treatment Insurance Denial?
If you or a loved one have received a hypertension treatment insurance denial, you have options. You can file an internal appeal, asking your insurer to reconsider its decision. You may include a letter from your doctor detailing why the treatment is necessary for your health. If the internal appeal is denied, you can file an external appeal with a neutral third party. If the external appeal is successful, your insurer will be forced to pay for your hypertension treatment. However, we recommend speaking with an experienced health insurance denial attorney first because in some cases, you may want to pursue legal options prior to an external appeal.
What Insurance Companies Are Known to Deny Hypertension Treatment?
Although any insurer can deny hypertension treatment, some are more likely to do so than others. Drugs like Ozempic, Wegovy, Saxenda, and Mounjaro are routinely denied, with most patients having to try several cheaper alternatives before the insurance company approves a weight loss drug. Some insurers in California that may deny your hypertension treatment include:
How the Law Offices of Scott Glovsky Can Help You with a Hypertension Treatment Insurance Denial
If you have received a hypertension treatment denial, it can be devastating, particularly if you and your doctor feel the treatment is absolutely necessary for your future health. After years of faithfully paying your monthly insurance premiums, it can feel like a betrayal when your insurer refuses to pay for a necessary treatment.
When your insurer falls short of providing the support you need and deserve, attorney Scott Glovsky is here to help you fight back. Scott has been helping people like you for many years. You deserve a strong advocate during this difficult time. Contact the Law Offices of Scott Glovsky today.