Ankylosing Spondylitis Insurance Denial Attorney

Page Contents:

• What is Ankylosing Spondylitis?
• What Drugs Are Typically Prescribed for Ankylosing Spondylitis?
• What Should You Do if Your Insurance Company Denies Treatment for Ankylosing Spondylitis?
• Top Questions Regarding Ankylosing Spondylitis 
  • Is ankylosing spondylitis treatment covered by insurance?
  • How expensive is it to treat ankylosing spondylitis?
• How The Law Offices of Scott Glovsky Can Help When Your Insurance Company Won’t Pay for Ankylosing Spondylitis Medication

As a rare form of arthritis that can cause pain and stiffness in the spine, ankylosing spondylitis is a lifelong condition that generally begins in the lower back, spreading up to the neck or other joints in the body. The word “ankylosis” means hard tissues or fused bones. “Spondylitis” refers to inflammation in the vertebrae or spinal bones. Ankylosing spondylitis may affect areas where a tendon or ligament attaches to a bone and can even result in the fusing of your vertebrae.

Ankylosing spondylitis is incurable, but there are certain medications that can help keep your back strong while easing the pain as well as certain exercises that can allow you to live better with ankylosing spondylitis. Ankylosing spondylitis can cause pain and stiffness in the lower back, buttocks, heels, feet, thighs, shoulders, hips, hands, or rib cage. Many of those with the disease report their pain is worse in the mornings when they get up or after they have been sitting for a significant length of time.

Other symptoms include trouble drawing a deep breath, joint swelling, chronic exhaustion, and a rigid spine that curves forward. In some cases, the vertebrae may weaken to the point that they fracture, and these damaged vertebrae can press on the nerves at the bottom of your spinal cord leading to the loss of reflexes, difficulty controlling the bowels or bladder, and sexual problems.

Nearly half of all those diagnosed with ankylosing spondylitis will develop an eye problem known as uveitis that causes painful inflammation to the eye, resulting in blurry vision and sensitivity to bright light. Occasionally, ankylosing spondylitis can result in an enlargement of the aorta, the largest artery in the body, allowing blood to leak back into the heart, causing extreme tiredness and shortness of breath.

For reasons not clearly understood, those with ankylosing spondylitis are more likely to develop bone and prostate cancers (men) and colon cancer (women). Ankylosing spondylitis is believed to be a genetic disease. Men are more likely than women to be diagnosed with the disease and it often strikers earlier and harder than in women. Nearly 80 percent of all cases of AS occur before the individual turns 30, and 95 percent by the age of 45.

Attorney Scott Glovsky In “Global Autoimmune Institute” Feature

Depending on the severity of your symptoms, your doctor may start you out with a prescription non-steroidal anti-inflammatory drug like Indocin (indomethacin), although in some individuals this drug could cause heart problems and stomach bleeding. More severe symptoms of ankylosing spondylitis could result in your doctor prescribing stronger medications like biologics.  Some drugs typically prescribed for this disease include:

• Azulfidine (controls pain and swelling in smaller joints)
• Rheumatrex (a chemo drug used in smaller doses to treat AS)
• Tumor necrosis factor blockers to reduce pain and stiffness (Humira, Cimzia, Enbrel, Simponi, Remicade)
• Interleukin-17 biologics to fight infection and reduce inflammation (Taltz, Cosentyx)

When an insurance company rejects a treatment or drug for ankylosing spondylitis, you can challenge its decision—successfully. In fact, you would be surprised how often persistence in this area pays off. According to National Nurses United, 80 percent of all claims denied as experimental or investigational were overturned or reversed by the insurer following a challenge. An older report from the US Government Accountability Office reveals that an appeal to the insurance company resulted in reversals of the decision 39 percent to 59 percent of the time.

It is understandable that while you are ill and not feeling well you simply do not have the energy necessary to fight your insurance company’s denial. Attorney Scott Glovsky is ready to take on that task on your behalf. At The Law Offices of Scott Glovsky, we fully understand that the outcome of your claim will affect your health and your future. We are never hesitant to take on billion-dollar insurance corporations on your behalf. 

While most health insurance plans will cover doctor’s visits and some prescription medications, your insurance company may not pay for biologic drugs or other higher-priced drugs. Physical therapy is often a key component of AS treatment, however, many insurance plans only cover 50-75 percent of the cost and only if the physical therapy is expected to deliver an “essential benefit.” Many plans also cap physical therapy costs at a specific number of sessions.

TNF blockers range from $740 per recommended dose of Humira to $2,315 for Cimzia. As you can see, a 20-30% co-pay for these drugs is substantial. The average cost of biologics can run from $10,000 to $30,000 per year, and sometimes even more. While insurance may cover a portion of this cost, it will depend on your specific insurance plan. Doctor visits for ankylosing spondylitis can run between $300 and $400 per visit and physical therapy from $75-$150 per session.

If your ankylosing spondylitis treatment was not approved, or your insurance company won’t pay for ankylosing spondylitis medication, you need a strong advocate in your corner who will take on the insurance company and fight to have the costs for your AS treatment covered by your insurer. Attorney Scott Glovsky is personally involved in every single case, working directly with every client. Scott believes in knowing the “story” of each client inside and out—after all, he cannot tell your story without knowing you and your story. Scott takes on fewer cases so he can personally devote the time and effort necessary to fully represent his clients. At The Law Offices of Scott Glovsky, we understand that when your insurance won’t pay for ankylosing spondylitis medications and treatments, your life and your future can be adversely affected.

At The Law Offices of Scott Glovsky, we do not run a “factory” firm. We take fewer cases, devote everything in our arsenal to the case, and aggressively seek justice for each and every client. If you have been wronged by your insurer—after faithfully paying your healthcare premiums—we will listen to you, support you, be available and responsive to you, and always place your needs first. Attorney Scott Glovsky is happiest when fighting for justice against a big insurance firm that thinks it is untouchable. If you are ill, depressed, and worried about your future, I will fight to make a real difference in your life. Contact The Law Offices of Scott Glovsky today for a free case review.