If you have received a plaque psoriasis treatment insurance denial, you may be feeling frustrated, perhaps angry, and certainly overwhelmed at the prospect of getting your insurer to change its decision. Plaque psoriasis is believed to be the result of an overactive immune system, environmental factors, and/or a family history of the disease, however, the precise cause is currently unknown. When an individual’s immune system “speeds up,” inflammation results, causing a larger-than-normal number of skin cells to grow.
While a person without any risk factors might simply slough off these skin cells, a person with plaque psoriasis will see those cells build up in layers on the skin’s surface, forming “plaques.” These plaques can cause self-consciousness on the part of the individual with the disease, so receiving a plaque psoriasis treatment insurance denial can be devastating. Attorney Scott Glovsky has been helping people in similar positions—those who have received insurance denials—for many, many years.
Why Might You Receive a Plaque Psoriasis Treatment Insurance Denial?
There are many new treatments used for plaque psoriasis, however, many of them are expensive. Expensive medical treatments are simply more likely to be denied by an insurance company. All insurance companies care about their financial bottom lines—in some cases, more than they care about those who pay insurance premiums. When a treatment is expensive, many insurance companies will issue a denial, claiming the treatment is “experimental,” “investigational,” or “medically unnecessary.” At this point, once a denial is issued, the vast majority of patients believe it’s “game over,” and they simply accept their insurer’s decision.
This is unfortunate since more than half of certain initial denials that go through the appeal process will reverse the denial. It can be difficult to think about working through the appeal process since it can be lengthy and complex when you are not feeling well or are taking care of a loved one who has medical problems. When you choose the Law Offices of Scott Glovsky, you can focus on your health while Scott and his team work tirelessly on your behalf to turn your plaque psoriasis treatment insurance denial into an approval.
What Should You Do for a Plaque Psoriasis Treatment Insurance Denial?
In some cases, an insurance denial can be easily fixed and reversed. Perhaps your forms were incomplete, or there were errors in your information or in the way the medical office coded the treatment. These are issues that can be easily corrected. If, however, you’ve been told your plaque psoriasis treatment is medically unnecessary, experimental, or investigational, you will almost certainly have to file an appeal.
In many states, you have 180 days from the date of your denial letter to file an internal appeal. This means that your insurance company is asked to take another look at your request. You can include a letter from your physician that clearly details why you need this specific treatment and how it will benefit you. If your internal appeal is denied, you can file an external review which goes to a neutral third party. The decision of your external review is legally binding—if the external review says your insurer must pay for your plaque psoriasis treatment, then it must do so. If your life, health, or ability to function could be in jeopardy because of the time it takes for an internal review, you can file for an expedited internal appeal. We recommend you contact an experienced health insurance denial attorney prior to filing an external appeal because in some cases it can be more beneficial to take legal action.
What Specific Insurance Companies Are Known to Deny Treatments?
Any insurance company can deny a medical treatment, although less expensive treatments are less likely to be denied. Since many of the newer plaque psoriasis treatments are fairly expensive, they are more likely to receive an insurance denial. Some of the most common health insurance providers in the state of California include:
More About Plaque Psoriasis
As many as 125 million people across the globe suffer from psoriasis. Plaque psoriasis is the most common type of psoriasis, accounting for about 80 percent of all cases of psoriasis. Plaque psoriasis can appear as raised flaky white or red patches covered with a silvery white buildup, or scales when a person with a lighter skin tone has the disease. On darker skin tones, the plaques may be darker and thicker, perhaps purple, brown, or gray in color. For reasons not clearly understood, plaque psoriasis typically appears in those between the ages of 20 and 30, or between the ages of 50 and 60.
What Are Some Newer Treatments for Plaque Psoriasis?
While there is no current “cure” for plaque psoriasis, there are newer treatments that have shown significant promise in controlling the disease. Bimzelx (received FDA approval in October 2023) is an interleukin-17A and interleukin-17F antagonist that inhibits these two key cytokines that increase the inflammatory process. Sotyktu (received FDA approval in September 2022) is a tyrosine kinase 2 inhibitor that decreases the inflammatory and immune processes in naturally occurring cytokines.
Skyrizi (received FDA approval in April 2019), Illumya (received FDA approval in March 2018), and Tremfya (received FDA approval in July 2017), are interleukin-23 antagonists that block IL-23 which is a pro-inflammatory cytokine. Interleukin-23 is believed to play a significant role in plaque psoriasis. These three drugs are called biologics and are administered via injection or IV infusion. Biologics are usually only used in those whose plaque psoriasis has not responded to phototherapy or topical treatments. The newest topical treatments used to treat plaque psoriasis include Zoryve (received FDA approval in July 2022) and Vtama (received FDA approval in May 2022).
Cosentyx, although an older drug to treat plaque psoriasis, remains one of the more expensive treatments, with a three-year cost of about $182,000. Bimzelx costs about $7,200 per syringe, and Sotyktu costs about $6,500 for 30 tablets. Illumya costs about 17,296 per injection, Skyrizi costs about $3,500 per dose, and Tremfya costs about $13,922 per injection. Topical Zoryve costs around $913 per tube, while topical Vtama costs approximately $1,467 per tube.
How the Law Offices of Scott Glovsky Can Help with a Plaque Psoriasis Treatment Insurance Denial
If you or a loved one has received a plaque psoriasis treatment insurance denial, you need someone to fight for you, your health, your family, and your future. Attorney Scott Glovsky is that person. At the Law Offices of Scott Glovsky, our overarching goal is to help those who have been wronged by an uncaring insurance company. We listen carefully to your issue, support you in every way possible, and will always be available and responsive. Attorney Scott Glovsky and his legal team will put your needs first, while always treating you with dignity and respect. Perhaps most importantly, we will fight for you as if you were a family member or close friend. We will fight for what is right, while always being 110 percent prepared. Contact the Law Offices of Scott Glovsky today.