Receiving an insurance denial—particularly when you or a loved one has a serious medical issue like lung cancer—can be devastating. Not only are you dealing with the illness itself every single day, but now you are being denied a treatment that your doctor feels will give you the very best chance of survival. A lung cancer treatment denial will not only damage your future but can also leave you feeling entirely overwhelmed and unsure of where to turn. Attorney Scott Glovsky has consistently been a strong advocate for those who have faithfully paid their insurance premiums only to be denied necessary treatment. When you turn to the Law Offices of Scott Glovsky, you can turn your entire focus on getting better while we handle all the details associated with a lung cancer treatment denial.
Why Might You Receive a Lung Cancer Treatment Denial?
There are many different reasons you could receive a lung cancer treatment denial. There are reasons that are fairly easy to correct and reasons that are much more difficult to fix. Treatments are often denied for benign reasons such as insufficient information or errors in the paperwork. There could also be mistakes in the coding. All of these issues are easily corrected. Your lung cancer treatment may have required prior authorization or there may be a specific exclusion in your policy for this type of lung cancer treatment. Unfortunately, many lung cancer treatment denials are the result of cost. In many cases, insurance companies care more about their financial bottom lines than those it insures.
When you receive a denial letter that states you are being denied because the treatment is “experimental,” “investigational,” or “not medically necessary,” then the reason behind the reason is likely that the treatment is expensive—your insurer simply does not want to pay. This is a time when you could significantly benefit from speaking to attorney Scott Glovsky from the Law Offices of Scott Glovsky. Scott deals with recalcitrant insurance companies every single day. It does not matter how big the insurance company is, Scott is ready to fight for you, your future, and for the treatment you need to get better.
Does Insurance Cover Cancer Treatment?
What Should You Do for Lung Cancer Treatment Denied by Insurance?
It’s important to know that you do have options following a lung cancer treatment denied by insurance. You can file an internal appeal that asks the insurer again to pay for the treatment. The internal appeal process can benefit from a letter from your doctor detailing why the prescribed lung cancer treatment is essential to your health and why the insurer should approve it. If your insurer denies your lung cancer treatment again, you can file an external appeal with a neutral third party. The decision made by this third party is legal and binding on your insurance company. Attorney Scott Glovsky can help you handle these appeals. Scott is well-versed in insurance appeals and will know the best way to get your insurer to approve your lung cancer treatment.
What Specific Insurance Companies Are Known to Deny Treatments?
Virtually any insurance company can issue a lung cancer treatment denial, however, some insurers may be more likely than others to do so. Very recently, Cigna denied coverage to a 47-year-old woman as she was preparing to undergo a lung transplant to treat her lung cancer. After arriving at the hospital in anticipation of her lung transplant, the woman was sent home and deactivated from the lung transplant waiting list. A public outcry on social media caused Cigna officials to say that denial of the lung transplant was an “error,” and the woman was placed back on the transplant list. California insurers who could issue a lung cancer treatment denial include:
How Serious is a Diagnosis of Lung Cancer?
Lung cancer is a complex disease with a variety of causes. There are different types of lung cancer tumors, as well as an array of symptoms. An accurate diagnosis is crucial for the best prognosis possible. Once a doctor suspects lung cancer, he or she may order imaging such as a CT scan, MRI, or PET scan. If these tests indicate lung cancer, a biopsy including Guardant 360 testing, ultrasound, mediastinoscopy, thoracoscopy, or wedge resection may be the next step. Once the doctor has staged the tumor, they have a better idea of how fast it will grow, how large the tumor is, and whether it has progressed beyond the initial site. Cancer treatments are changing rapidly, with new innovations and new treatments that can save lives.
What Are Some Newer Treatments for Lung Cancer?
Targeted therapy, immunotherapy, and combinations of these approaches are also likely to be used following a lung cancer diagnosis. Some of the newer lung cancer treatments include:
- On March 26, 2024, the FDA approved Winrevair™ (Sotatercept-csrk), a biologic medication to treat pulmonary arterial hypertension (PAH). PAH is a progressive, rare disease that leads to death. This medication is the first that targets the underlying cause of lung cancer. The Phase 3 STELLAR clinical study showed it improved both quality of life and exercise duration, and delayed the worsening of lung cancer and death.
- Osimertinib (Tagrisso) was approved by the FDA in 2021 to be given following surgery to those with early-stage lung cancer that has certain mutations in the EGFR gene.
- Atezolizumab (Tecentriq) and pembrolizumab (Keytruda) are immunotherapy drugs that are often used following lung cancer surgery and chemotherapy for certain patients with early-stage NSCLC (Non-small-cell lung cancer).
- Another immunotherapy drug, nivolumab (Opdivo) is used along with chemotherapy to treat early-stage lung cancer before lung cancer surgery. Opdivo was approved by the FDA in 2022 following a study that showed lung cancer patients who received Opdivo in conjunction with chemotherapy lived longer than those who received only chemotherapy.
Advanced lung cancer treatments can include immunotherapy drugs and targeted therapies as well as immune checkpoint inhibitors—drugs that block the interaction between proteins on immune cells and cancer cells, thus lowering the lung cancer’s immune response. Targeted therapies for advanced lung cancer could include:
- ALK (Anaplastic lymphoma kinase) inhibitors (alectinib, brigatinib, ceritinib, lorlatinib, and crizotinib)
- EGFR inhibitors (Tagrisso is the most effective and widely used EGFR inhibitor used for advanced lung cancer treatment).
- ROS1 inhibitors (Xalkori, Zykadia, Lorbrena, Rozlytrek)
- BRAF inhibitors (Tafinlar and Mekinist)
- Other inhibitors like Vitrakvi, Tepmetko, Tabrecta, Retevmo, and Gavreto
Is There a New Lung Cancer Pill That Is Showing Remarkable Results?
Osimertinib, sold under the brand name Tagrisso, is prescribed to those with Stage 1 B-3A lung cancer who have a specific genetic mutation and have had surgery to remove cancerous tumors. Tagrisso has been proven to reduce the five-year risk of recurrent lung cancer by up to 73 percent, and the risk of lung cancer death by up to 51 percent, according to a recent Fox News article. When asked about these statistics, Dr. Faiz Y. Bhora, chief of thoracic surgery at Hackensack Meridian Health in New Jersey stated, “In the world of oncology, that is earth-shattering.”
To determine whether a patient has the EGFR mutation and is eligible for Tagrisso, a tissue sample is extracted from the tumor and tested. Bhora also stated that about 25 percent of those diagnosed with lung cancer do have the EGFR mutation and that lung cancer is no longer a “smoker’s illness.” In fact, about 30 percent of those diagnosed with lung cancer have never smoked. Since there are about 240,000 patients diagnosed with lung cancer every year, Tagrisso is an exciting new treatment for those with lung cancer.
How the Law Offices of Scott Glovsky Can Help
If you or a loved one has been diagnosed with lung cancer and your insurer is refusing to pay for a drug like Tagrisso that could significantly extend life, attorney Scott Glovsky can help. At the Law Offices of Scott Glovsky, we understand how devastating a lung cancer treatment denial can be. We believe in your right to get the treatments your doctor believes will give you the best chance for survival and the ability to live a life without cancer symptoms.
Attorney Scott Glovsky is happiest when he is fighting for justice against large insurance companies who believe they are untouchable. When a lung cancer treatment denial takes you to the lowest point in your life, Scott Glovsky steps in to make a positive difference in your future. Contact the Law Offices of Scott Glovsky today to get the help you need and deserve.