Being diagnosed with leukemia could be one of the worst things to happen to you, whether the diagnosis is for you or a loved one. Leukemia is a type of cancer that starts in the blood-forming cells in the blood marrow. While leukemia is most often found in the white blood cells, it can develop in other types of blood cells and is the most common type of childhood cancer. According to the American Cancer Society, it is estimated that about 59,610 new cases of all types of leukemia will be diagnosed in 2023, with 23,710 leukemia-related deaths during the same timeframe.
About 20,380 new cases of acute myeloid leukemia will be diagnosed in 2023, primarily among adults, with about 11,310 deaths from AML. While AML is one of the most common types of leukemia among adults, it remains relatively rare, accounting for about 1 percent of all cancers. While AML does occasionally occur in children, it is much more common among older individuals with an average age at diagnosis of 68. At a time when you may be struggling simply to survive, having a leukemia treatment denied by insurance can feel overwhelming.
It is extremely beneficial to have a strong legal advocate by your side during this difficult time. Attorney Scott Glovsky helps people in similar situations as yours every single day. After working for a time on the other side—for big insurance companies—Scott knows every trick in the books and every tactic insurance companies use to deny a legitimate claim. This is not something you have to face alone. The Law Offices of Scott Glovsky are waiting to help you get the treatments you need for your leukemia diagnosis.
Why Might a Leukemia Treatment Be Denied by Insurance?
Whether for leukemia or other serious illnesses, insurance companies often deny the medical treatments that will cost the most money under the guise of it being “not medically necessary,” “experimental,” or “investigational.” Of course, medical treatments may also be denied because of improperly filled out forms—something that can be easily remedied—or because the treatment is specifically excluded under the policy. Medical treatments could also be denied due to a lack of pre-authorization.
When all is said and done, however, big insurance companies are concerned with their financial bottom line. Any treatment that is going to cost them more than their pre-determined “acceptable” level of cost is likely to be denied. Many people either don’t know they have the right to appeal an insurance denial, don’t have the time necessary, or feel like it wouldn’t do any good to appeal. It is important to have a strong legal advocate like attorney Scott Glovsky in your corner to help you get the medical treatments you need to treat your leukemia.
Specific Types of Leukemia Treatments That Might Be Denied
A leukemia treatment denied by insurance can leave you feeling hopeless—even helpless. Some of the most common types of leukemia treatments that might be denied by your insurance company include:
Chemotherapy is the major form of treatment for leukemia, and because it has been used for so long, it is virtually always covered under health insurance unless your policy specifically excludes it.
Targeted therapy may be used to treat certain types of leukemia like chronic lymphocytic leukemia. Targeted therapy uses drugs to target specific molecules that tell cells to grow and divide such as:
- Tibsovo, which can cost almost $32,000 for 60 tablets
- Gleevec, which costs about $9,000 for 90 tablets
- Sprycel, which costs about $16,794 per month
- Tasigna, which costs about $4,895 per month
- Iclusig, which costs about $21,202 for 30 tablets
Radiation therapy, like chemotherapy, is an accepted form of treatment for many different cancers, including malignant neoplasms, lymphoma and leukemia, so radiation treatment is rarely denied unless specifically excluded under your policy.
Bone marrow transplants are usually covered under insurance, although some insurance companies only cover the cost of the actual treatment and will not cover the costs associated with finding a donor, which can be extremely expensive. The cost of a bone marrow transplant can be from $350,000 to $800,000, depending on whether your own marrow or stem cells are used, or a donor is necessary.
Immunotherapy drugs used to fight leukemia usually include CAR T-cell therapy. Immune cells (T-cells) are removed from the blood, then genetically altered in the lab to have specific receptors known as CARs (chimeric antigen receptors) on the surface. These receptors then attach to the proteins found on leukemia cells. CAR T-cell therapy can cost from $500,000-$1,000,000.
Other Leukemia drugs like Calquence, Gazyva, Imbruvica, and Rituxan are also used, depending on the type of leukemia.
What Should You Do if Your Leukemia Treatment is Denied by Insurance?
If you are facing a leukemia treatment denied by insurance, you have options. You can file an appeal directly with the insurance company, which may include a letter from your doctor reiterating why this particular treatment for your leukemia is medically necessary or why it is not experimental or investigational. If your initial appeal is denied, you can file a third-party external appeal where your denial will be investigated, and a decision made that is binding for the insurance company. Prior to filing an external appeal, however, we recommend you speak with an experienced health insurance denial attorney. And the reason is that the attorney may recommend you follow a different path since the chance of overturning a third party appeal decision is difficult.
What Insurance Companies Are More Likely to Deny Leukemia Treatments?
While any insurance company may deny a leukemia treatment, some companies are more likely to do so. Some of the California health insurers that may deny leukemia treatments include:
What are the Primary Leukemia Drugs Denied by Insurance?
Imbruvica, used in combination with Rituxan, or Calquence, used in combination with Gazyva, are among the most commonly prescribed drugs for those diagnosed with leukemia. Although FDA-approved, these drugs are expensive. Imbruvica ($13,546 per month) is a small molecule drug that inhibits B-cell proliferation and survival by binding a specific protein, while Rituxan ($53,999 annually) is a monoclonal antibody medication. Calquence ($15,721 for 60 tablets) is used to treat adults with chronic lymphocytic leukemia, while Gazyva ($41,000 for six months) is a humanized anti-CD20 monoclonal antibody drug.
What Are the Leukemia Survival Rates When Treated Appropriately?
Survival rates for leukemia depend heavily on age at diagnosis, overall health, and whether appropriate treatment is received as well as on the specific type of leukemia. When appropriately treated, acute lymphoblastic leukemia has a five-year survival rate of about 71 percent, acute myeloid leukemia has a five-year survival rate of about 31 percent, chronic lymphocytic leukemia has a five-year survival rate of about 88 percent, and chronic myeloid leukemia has a five-year survival rate of about 70 percent. It is important that you receive the leukemia treatment your doctor recommends as a means of significantly increasing your chances of living a long, healthy life. A leukemia treatment denied by insurance can be promptly addressed by experienced insurance denial attorney Scott Glovsky.
How the Law Offices of Scott Glovsky Can Help When Your Leukemia Treatment is Denied by Insurance
When you choose the Law Offices of Scott Glovsky for a leukemia treatment denied by insurance you can expect highly personal and caring client attention. Our firm works hard to ensure that every single client feels like they have a strong ally in their corner—someone who will always go the extra mile for them and will fight for their rights and future. The Law Offices of Scott Glovsky is well respected, with a solid reputation in the industry.
Many of our cases are referred by other attorneys who are aware of our expertise in this area. Opposing attorneys sit up and take notice when attorney Scott Glovsky is on the other side of the aisle. If you want passion, commitment, experience, and knowledge, contact the Law Offices of Scott Glovsky today for assistance with your denied medical treatment.