If you’ve had a malignant neoplasm treatment denied by insurance, you may be feeling anxious, stressed, or even frightened. And you may be angry with your insurance company. After all, you’ve held up your end of the bargain by consistently paying your monthly health insurance premiums, but now that you need your insurer to hold up its end of the bargain, it is balking. While insurance companies may offer many reasons why they are denying treatment, it sometimes comes down to one thing—money.
The insurance company is very focused on its financial bottom line, and if you are asking it to approve an expensive treatment, it may look for a way out. Unfortunately, many people do not pursue the matter. Once the insurance company denies payment they will simply do without the treatment, believing it is useless to fight. In fact, nothing could be further from the truth. When you have a strong legal advocate like attorney Scott Glovsky by your side throughout the process, it becomes much more difficult for the insurance company to deny a legitimate procedure.
In the case of a malignant neoplasm treatment, it can be particularly distressing to receive a denial, since this is a very serious disease. A malignant neoplasm is a cancerous tumor that is highly likely to metastasize or spread throughout the body. This is an instance where you absolutely need the treatment prescribed by your doctor—for your very life. The Law Offices of Scott Glovsky is ready to fight for the treatments you need for your malignant neoplasm.
Why Might a Malignant Neoplasm Treatment Be Denied by Insurance?
Insurance companies deny medical treatments for a variety of reasons. The simplest reason could be that you did not complete a form, or the form was incorrectly filled out. The treatment could have been miscoded by your doctor’s office, or the treatment may have required prior authorization. You should take a look at your insurance policy to see if the specific malignant neoplasm treatment is excluded. The letter sent to you by your insurance company should clearly state why the malignant neoplasm treatment is being denied. The insurer may claim that the treatment is not medically necessary, or that it is “experimental,” or “investigational.” Sometimes this determination correlates with very expensive treatments.
Specific Types of Malignant Neoplasm Treatments That Might Be Denied
Some of the most common types of malignant neoplasm treatments include:
Surgery to remove as much of the cancerous tumor as possible
Chemotherapy, using anti-cancer drugs to destroy cancer cells
Hormone therapy that reduces the natural level of hormones in the body or blocks hormones from reaching the cancer cells
Targeted therapies that destroy cancer cells by interfering with the ability of the cancer to grow while stimulating the body’s natural immune system. Targeted therapies include:
- Monoclonal antibodies
- Cancer growth inhibitors
- Angiogenesis inhibitors
- Stem cell or bone marrow transplants
What Should You Do if Your Malignant Neoplasm Treatment Is Denied by Insurance?
Of course, it is distressing to have your malignant neoplasm treatment denied by insurance. At a time when you are likely feeling poorly, wanting only to focus on getting better, you must fight your insurance company for necessary treatment. While there are things you can do, the best step you can take is to speak to an experienced California insurance denial attorney like Scott Glovsky. Scott can guide you to file an internal appeal as well as an external third-party appeal if the internal appeal is unsuccessful. But he may counsel you to take a different path than the third-party appeal based on your particular situation.
Scott knows the process inside out and will help ensure that no deadlines are missed and that you have the best chance of success. It can be helpful for you to obtain a letter from your doctor that details why the malignant neoplasm treatment prescribed is necessary for your health, and you should take care to keep all correspondence related to the treatment and the denial of the treatment thorough and organized.
What Insurance Companies Are More Likely to Deny Malignant Neoplasm Treatments?
While any insurance company can deny your malignant neoplasm treatment, some are more likely to do so than others. According to CNN, in 2019 one federal judge, apparently fed up with insurance company denials of necessary medical treatments, blasted UnitedHealthcare for “immoral and barbaric” denials of treatments for cancer patients. Some California insurance companies that could potentially deny your treatment include:
Why Are Monoclonal Antibodies Often Denied by Insurers?
Monoclonal antibodies can be a malignant neoplasm treatment denied by insurance. Monoclonal antibodies are antibodies that are designed by researchers to specifically target an antigen found on cancer cells. Copies of that antibody are then created in a lab and are known as monoclonal antibodies. These monoclonal antibodies are used to treat some types of cancers, however, can be expensive to produce. For this reason, insurance companies may deny the malignant neoplasm treatment when it includes monoclonal antibodies.
What Are Angiogenesis Inhibitors?
Angiogenesis inhibitors are a type of cancer treatment that stops a process in the body known as angiogenesis (blood vessel formation). To grow, a tumor needs nutrients and oxygen from your blood, so the tumor sends out signals to stimulate more blood vessels to grow and carry more blood. Angiogenesis inhibitors block nutrients and oxygen from the tumor or neoplasm, essentially starving the tumor. There are many different approved angiogenesis inhibitors to treat malignant neoplasms. The type of angiogenesis inhibitor will depend on the type and stage of the cancer.
For instance, Inlyta treats kidney cancer, Avastin treats cervical, colorectal, liver, kidney, ovarian, fallopian tube, and peritoneal cancers, Cometriq treats differentiated thyroid cancers as well as kidney and liver cancer, and Afinitor treats breast cancer, gastrointestinal cancer, lung cancer, pancreatic cancer, and kidney cancer. Similar angiogenesis inhibitors include Revlimid, Lenvima, Votrient, Cyramza, Nexavar, Sutent, and Synovir. These treatments can cost $9,000 per month and up—which may be why they are often denied by insurers.
How the Law Offices of Scott Glovsky Can Help When Your Malignant Neoplasm Treatment is Denied by Insurance
When your malignant neoplasm treatment is denied by insurance it can feel like the end of the world. You are already sick and fighting for your future, so dealing with a denial like this can feel overwhelming. You need an attorney who steps in immediately and goes to bat for you. That attorney is Scott Glovsky. Scott and his legal team are different from other firms. Our practice is geared entirely toward our clients.
We take fewer cases so we can devote the necessary time, attention, and care to each and every case. We know how insurance companies operate and are familiar with their tactics. This allows us to stay a step ahead at every turn. Among the legal industry, the Law Offices of Scott Glovsky is highly respected. We want to help you during this difficult time—contact the Law Offices of Scott Glovsky today.