Attorney for Prostate Cancer Treatment Denials
Unfortunately, a prostate cancer treatment denied by insurance can affect not only your finances but also your health and your future. All too often, huge insurers make decisions based on their own financial bottom line rather than on the people who pay their monthly premiums and desperately need a specific treatment to get better—or even to survive. In 2019, a federal judge had some harsh criticism of UnitedHealthcare regarding its “immoral and barbaric” denials of treatments for cancer patients.
Specifically, Judge Robert N. Scola was referring to proton beam therapy, a new prostate cancer treatment option that is a precise form of cancer treatment with fewer side effects. Despite considerable evidence that proton therapy is effective, insurers—like UnitedHealthcare—are denying coverage for the treatment by calling it “experimental.” It is undisputed, however, that medical experts find proton radiation therapy is not experimental and that it causes much less collateral damage than traditional radiation.
Why Might Your Prostate Cancer Treatment Be Denied by Insurance?
There are a number of reasons your prostate cancer treatment could be denied by insurance. A claim could be denied because you did not secure prior authorization or did not have a referral. Perhaps you inadvertently used an out-of-network provider or the treatment your doctor recommended was specifically excluded from your healthcare plan. In some cases, the denial could be related to something simple like an improperly filled out form, or something else that can be easily fixed. Other times, your insurer may deny your claim based on a lack of medical necessity or a claim that the treatment is investigational. Neither of these things could be true, rather the denial could be wholly related to the cost of the treatment.
What Should You Do About Prostate Cancer Treatment Denied by Insurance?
If your doctor has prescribed a treatment for your prostate cancer then your insurer denied that treatment, you may be unsure of what you need to do for your health and your future. If your claim was denied due to an error, you can fix the error and resubmit.
If your insurer is claiming that the prostate cancer treatment your doctor recommends is experimental or investigational, your next step should be to speak to a knowledgeable prostate cancer treatment insurance denial attorney from the Law Offices of Scott Glovsky. We will help you take the next step, which is filing an internal appeal. In this step, you are asking your insurer to reconsider its decision.
Your insurer will either approve the treatment at this point or continue denying the prostate cancer treatment. It’s important that you do not give up. We will help you file an external appeal, which means an independent third party will review your claim, making a decision as to whether your insurer should pay for the treatment.
Which Insurers Are Most Likely to Deny Your Prostate Cancer Treatment?
Although any insurance company can deny your prostate cancer treatment, some companies may be more likely to do so than others. As noted above, UnitedHealthcare made the news for refusing to approve proton beam therapy, despite solid evidence of its efficacy. Insurers in California who may deny your prostate cancer treatment include UnitedHealthcare, Anthem Blue Cross, Blue Shield, HealthNet, Kaiser, or Aetna. It really doesn’t matter which insurer denies your claim—attorney Scott Glovsky has gone up against every large insurance company, with impressive results.
What Prostate Cancer Treatments Are Most Likely to Be Denied?
- Laser ablation uses laser radiation energy pinpointed to burn only the cancerous areas. In some cases, laser ablation can be performed at the same time as an MRI, allowing even more specific targeting of the cancerous areas as well as immediate views of the results of the laser ablation. Laser ablation can cost from $6,000-$20,000 per use.
- Proton beam therapy is a non-invasive external radiation treatment that targets and destroys cancer cells by disrupting their DNA. Proton beam therapy precisely targets prostate tumors, sparing organs and tissues surrounding the tumor while killing the cancerous cells. Proton beam therapy costs from $30,000 to $120,000.
- A combo drug therapy (Talapro-2) for men with metastatic castration-resistant prostate cancer combines two drugs—Talzenna and Xtandi. Talazoparib (Talzenna) is a hormone therapy that works by blocking testosterone, which in turn prevents the prostate cancer cells from growing—even those that have spread to other parts of the body. Talapro-2 is not yet on the market but is expected to be soon. Talzenna belongs to a class of drugs known as PARP inhibitors. PARP is a protein found in cells that assists cells damaged by cancer to repair themselves. PARP inhibitors block the repair function in cancer cells, causing the cells to die. PARP inhibitors, when combined with the testosterone blocker enzalutamide (Xtandi), can provide better results to prostate cancer patients than either drug on its own. Either drug may still be given on its own. A one-month supply of Talzenna is about $6,157, while a one-month supply of Xtandi is about $14,382 for 120 capsules, Talapro-2 will likely reflect those costs and could be even more expensive.
- High-intensity focused ultrasound (HIFU) ablates cancer-ridden prostate tissues. HIFU is extremely focused, treating only the area with the aggressive tumor, leaving the rest of the prostate and surrounding tissues and organs alone. If there are multiple tumors, the largest tumor with the highest grade will be targeted first. A HIFU procedure is usually well-tolerated and performed as an outpatient procedure with same-day discharge. While urinary incontinence can result from HIFU, it is much less likely to occur with HIFU treatment than with other common prostate cancer treatments.
- LHRH (luteinizing hormone-releasing hormone) agonists are used as an androgen deprivation therapy for those with advanced prostate cancer. The LHRH agonists diminish testosterone with the goal of shrinking prostate cancer cells.
- Pluvicto is used for men with advanced prostate cancer that has potentially spread to other parts of the body. Pluvicto is a targeted radioligand therapy, using radioactive atoms to deliver radiation to targeted cells. The treatment fights cancer while limiting the damage done to surrounding tissues. While there is no “cure” for advanced prostate cancer, Pluvicto allows those with late-stage prostate cancer to live longer. Studies have shown that those who took Pluvicto lived a median of about 15 months after diagnosis, or about four months longer than those who did not take Pluvicto. With relatively few side effects, Pluvicto is also easily administered. Pluvicto is an IV solution given every 6-10 weeks, for a total of no more than six treatments. Pluvicto costs about $45,000 per treatment.
Any prostate cancer treatment can potentially be denied, but typically, the higher the cost of the treatment, the more likely it is to be denied by an insurer.
How Can You Get the Help You Need for Prostate Cancer Treatment Denied by Insurance?
This is one fight that you don’t need to fight on your own. It’s always better to have a strong advocate by your side who has experience going up against a huge insurance company, making it pay for necessary cancer treatments. When you have Scott Glovsky as your prostate cancer treatment insurance denial attorney, he will fight against unfair, improper denials. Scott is passionate about what he does, taking swift, decisive action on your behalf to address denied prostate cancer treatments. When litigation is necessary, Scott will represent you in a claim for insurance bad faith, breach of contract, or fraudulent practice.
Getting the Help You Need from the Law Offices of Scott Glovsky
A denial of a prostate cancer treatment can be devastating. Perhaps your doctor believes the treatment will help you beat prostate cancer altogether, or that the drug can give you more time with your loved ones. Having your hope for a future dashed by an insurer who simply doesn’t want to pay for a specific prostate cancer treatment can be devastating. You need an attorney who will be your champion, passionately fighting for your future. Scott Glovsky is that attorney.
Scott is happiest when he and his legal team are fighting for justice against big corporations that believe they are untouchable. At the Law Offices of Scott Glovsky, we want you to know you are no longer in this fight alone. We are committed to getting you the prostate cancer treatments you need while working tirelessly to ensure you get the justice you deserve as well. For prostate cancer treatment denied by insurance, contact the Law Offices of Scott Glovsky.