Norditropin Insurance Denial Attorney in California
Norditropin is a treatment for adults and children diagnosed with growth hormone deficiency or for children with other growth-related disorders. It has been used for more than 25 years and is the most often prescribed growth hormone therapy on the market. Norditropin is prescribed for the following medical conditions:
- Children with Turner syndrome and Noonan syndrome, those who are short in stature or were born small, and those who have not caught up to their peers in growth by two to four years of age.
- Children who lack growth hormone in their body and are not growing as a result.
- Children with Prader-Willi syndrome
- Children with Idiopathic Short Stature
- Adults who are lacking in growth hormone
It can be extremely difficult and disheartening for those with any of the above medical issues to have an insurance company deny a doctor’s recommendation for Norditropin. Norditropin denied by insurance may occur for a variety of reasons, but it is important that you do not give up. Many insurance denials can be reversed when the proper channels are followed, and an experienced insurance denial attorney is on the case.
What Are Growth Hormones?
Growth hormone is a naturally occurring protein that plays a key role in our bodies’ growth and metabolism. A hormone is like a messenger; it travels throughout our bloodstream, telling different body parts to do certain jobs. From the time we are children, growth hormones – which are made by the pituitary gland – tell our cells to grow and divide. The pituitary gland is a pea-sized gland at the base of the brain. When growth hormone reaches the liver, it instructs the liver to release a second hormone, insulin-like growth factor-1 (IGF-1). IFG-1 also stimulates growth, working with growth hormones to tell tissues, organs, muscles, and bones to grow.
What Causes Lack of Growth Hormones?
Growth hormone deficiency, sometimes known as pituitary dwarfism or dwarfism, affects children with normal body proportions but abnormally short stature. It can be present at birth or may develop later. Growth hormone deficiency may also result from being born without a pituitary gland, a severe brain injury, or a genetic defect.
There are some cases when there is no clear cause for growth hormone deficiency, although in some cases, it can be associated with low levels of other hormones, including vasopressin, gonadotropin, thyrotropin, or the hormone that controls the adrenal gland (adrenocorticotrophic hormone). In addition to slow growth or short stature, growth hormone deficiency can result in delayed or absent sexual development during puberty, chronic, severe headaches, increased urination, and excessive thirst.
Facial abnormalities may be seen in a small group of children with growth hormone deficiency. Blood tests can measure the level of growth hormone in the body, and imaging tests like X-rays and MRIs can help narrow down the underlying disorder. The physician will usually measure height, weight, and arm and leg lengths to determine how severe the growth hormone deficiency is.
Growth hormone deficiency can often be successfully treated with synthetic growth hormones like Noridtropin. Norditropin is an injection containing recombinant human growth hormone, a polypeptide of recombinant DNA synthesized by a special strain of E. coli bacteria modified to carry the gene for human growth hormone.
Why Could Norditropin Be Denied by Insurance?
There are many different reasons an insurer could deny a medical claim. In many cases, there are errors on the claim form that must be resolved or insufficient information submitted with the claim. After fixing these errors or omissions, the claim can be resubmitted and will likely be approved.
Other times, the insurer may tell you that the treatment requires prior authorization, step therapy, or that the treatment is specifically excluded from your plan. Step therapy means you must try other, less expensive treatments, and those treatments must not work for you before the insurance company will approve the more expensive treatment.
If you receive a denial letter that says Norditropin was denied because the insurer believes it is “medically unnecessary,” “experimental,” or “investigational,” this could mean that the treatment is expensive, and the insurer simply does not want to pay. A month’s supply of Norditropin can cost as much as $6,000. This means that “not medically necessary” may translate into “It costs too much.”
What Should You Do if You Receive a Norditropin Denial?
If you receive a Norditropin denial, you can file an internal appeal, which means you will ask your insurance company to take another look and reverse its decision. It can be beneficial to have your doctor write a letter that details why you or your child need Norditropin, and how it will benefit the underlying medical condition.
You can file an external appeal if your insurer still refuses to pay for Norditropin. This appeal is filed with a neutral third party whose decision is legal and binding on the insurance company. Having an experienced insurance denial attorney from the Law Offices of Scott Glovsky by your side can make a significant difference in the outcome of your appeals.
Which Insurance Companies Are Most Likely to Deny Norditropin?
While any insurer can deny Norditropin or any other expensive medical treatment, some insurers may be more likely to do so than others. Within the state of California, some of the most common health insurance companies include:
- Anthem Blue Cross
- Blue Shield
- Health Net
- Kaiser
- Cigna
- Aetna
- Medi-Cal Managed Care Plans (Anthem Blue Cross, Promise Health Plan, Health Net, Molina)
Why You Should Choose the Law Offices of Scott Glovsky
Few attorneys have made it their mission in life to help those who are suffering because a big insurance company does not want to pay. Scott Glovsky started his career working for these big insurance companies but soon changed to the “other” side so he could bring justice to people who would otherwise never experience it. Attorney Glovsky founded his firm in 1999 to hold big corporations accountable for putting their bottom-line profits ahead of people’s lives. Scott works every day to change the system so others will not suffer needlessly. Contact the Law Offices of Scott Glovsky to discuss your insurance denial.