What is Ulcerative Colitis?
2023 Update: We filed this case against UnitedHealthcare that resulted in the insurer overturning its denial of medically necessary ulcerative colitis biologic medications.
Affecting the innermost lining of your large intestine and rectum, ulcerative colitis is an inflammatory bowel disease that causes inflammation in the digestive tract, along with sores or ulcers in some cases. Symptoms of ulcerative colitis tend to develop over time. While there is currently no cure for ulcerative colitis, there are treatments available to help manage the disease.
Sometimes, the body’s immune system makes a mistake, attacking the cells’ lining the colon, good gut bacteria, and food in the same way it would attack a real intruder (like the flu virus). The lining of the colon is attacked by white blood cells that would normally protect it. Researchers have found no clear reason why some people develop ulcerative colitis although they have found that it tends to run in families, so may have a genetic component.
While specific foods or stress do not cause ulcerative colitis, they can trigger a flare-up. Those of Ashkenazi Jewish descent tend to have ulcerative colitis more often than other ethnicities. Individuals between 15 and 30 or those over the age of 60 are more likely to be diagnosed with the disease. There are five types of ulcerative colitis:
- When colitis affects the entire colon, causing severe pain, fever, bleeding, and heavy diarrhea, it is known as acute severe colitis. This form of ulcerative colitis is relatively rare.
- Pancolitis also affects the entire colon; along with the symptoms of acute severe colitis, pancolitis symptoms include major weight loss, stomach cramps, fatigue, and bloody diarrhea.
- When cramps are on the left side of the belly and the individual is losing weight without trying, the diagnosis may be left-sided colitis, which causes inflammation from the rectum through the left side of the colon.
- If the colitis is in the rectum and the lower end of the colon, it is known as proctosigmoiditis. This form of ulcerative colitis causes belly cramps, pain, bloody diarrhea, and the urge to empty your bowels—but the inability to do so.
- The mildest form of ulcerative colitis is proctitis which is only in the rectum. The only sign of the disease could be rectal bleeding.
Ulcerative colitis can be debilitating—in some cases, life-threatening. Treatments can significantly reduce the symptoms of ulcerative colitis, bringing about long-term remission.
What Drugs are Typically Prescribed to Treat Ulcerative Colitis?
If you have been diagnosed with ulcerative colitis, you could be prescribed anti-inflammatory drugs, immune system suppressors, or a biologic drug—or a combination of these. Anti-inflammatories include 5-aminosalicylates (Azulfidine, Asacol HD, Delzicol, Colazal, or Dipentum). Which of these drugs your doctor will prescribe will depend on the area of your colon affected by ulcerative colitis. Corticosteroids are also a form of anti-inflammatory used to treat ulcerative colitis but are not generally prescribed long-term.
Immune system suppressants include Azasan, Purinethol, Purixan, Neoral, Sandimmune, Gengraf, and Xeljanz. Xeljanz may be prescribed when other therapies do not work, although it can have serious side effects such as shingles and blood clots. Biologic drugs target proteins made by the immune system and may include Remicade, Humira, Simponi, Entyvio, and Stelara. Sometimes a combination of biologics is prescribed for a patient. While surgery can eliminate ulcerative colitis, it involves removal of the entire colon and rectum, constructing a pouch from the end of the small intestine, then attaching it to the anus.
What Should You Do if Your Insurance Company Won’t Pay for Ulcerative Colitis Medication?
If your insurance company won’t pay for ulcerative colitis medications that your physician believes are necessary to treat your disease, you may be uncertain of what you need to do. In some cases, the insurance company may require step therapy. This means you will be required to take a less expensive medication—or perhaps several—for up to 60 days to see if the medication works for you before your insurer will pay for a more expensive drug. Your insurer could refuse to pay for biologics at all, due to the cost, yet a biologic medication could make a significant difference in your life and your future. Contacting The Law Offices of Scott Glovsky can be the best decision you make during this difficult time. There’s no downside to contacting Scott today, the case evaluation is completely free. Plus Scott has had cases like this in which insurers deny ulcerative colitis medications.
Attorney Scott Glovsky will take this burden from you, fighting on your behalf for the drugs you need for your ulcerative colitis. Scott really cares about his clients, taking on fewer cases so he can personally devote the tremendous amount of time and effort necessary to fully represent his clients. Scott believes he can best assist his clients when he knows and understands them so he can tell their stories. At The Law Offices of Scott Glovsky, we understand that the outcome of your appeal to your insurer could affect your life and your family’s lives and future. We work hard to obtain justice on your behalf.
FAQs Regarding Ulcerative Colitis Insurance Coverage
Is ulcerative colitis treatment covered by insurance?
Although ulcerative colitis is likely covered under your health insurance plan, there may be specific treatments and prescription drugs that your insurance company denies. Unfortunately, a long-term illness like ulcerative colitis can put a serious strain on your budget, even when your insurer does pay its share of the costs. In fact, according to WebMd, those with ulcerative colitis tend to pay twice the amount of out-of-pocket medical costs, and up to three times more for treatment.
How expensive is it to treat ulcerative colitis?
If other treatments for your ulcerative colitis are unsuccessful, your doctor may consider surgery, which can cost $40,000 and up. Depending on the type of drug you take, your pharmacy costs could be up to $30,000 without insurance. Even with insurance, if you pay a 30 percent co-pay, you could be looking at $5,000-$10,000 in co-pays for the medication prescribed by your doctor. Some of these drugs are even more expensive. As an example, a 30-day supply of Stelara is $12,332, while a 30-day supply of Humira is from $6,129 to $11,328.
How Scott Glovsky Can Help When Your Ulcerative Colitis Treatment is Not Approved by Insurance
If your ulcerative colitis treatment was not approved or your insurance company won’t pay for ulcerative colitis medication, you need experienced, compassionate help. The Law Offices of Scott Glovsky has helped many people in your same situation—we have a successful track record going back more than two decades. Attorney Scott Glovsky is personally involved in every case so when you hire the firm, you hire him. Your trial lawyer needs to know your case inside and out—which is exactly what Scott Glovsky does with each and every client. Scott takes every case seriously—and personally because he’s passionate about fighting for those in need of help. At The Law Offices of Scott Glovsky, we understand that you may be feeling anxious, depressed, powerless, or even abandoned. While this may certainly feel like a low point in your life, one phone call gets you a strong advocate who can and will make a difference in your life. We fight insurance companies every day so we know how to persuade your insurer to pay for the ulcerative colitis treatments you need. Contact The Law Offices of Scott Glovsky today for a 100% free case evaluation.