Brain Cancer Treatment Insurance Denial

As many as one million Americans are currently living with a primary brain tumor. About 72 percent of all brain tumors are benign, while 28 percent are malignant. Females are more likely than males to be diagnosed with a brain cancer tumor (59 percent vs. 41 percent). The median age at diagnosis for a primary brain tumor is 61 years, and survival rates will vary by age at diagnosis and tumor type. 

Brain cancer was the 10^th leading cause of cancer deaths in 2023 for both males and females in all age groups. It can be difficult for a person diagnosed with brain cancer – or the parent of a child or other loved one diagnosed with brain cancer – to also deal with a brain cancer treatment insurance denial. 

While any insurance claim denial can be devastating, one for brain cancer or another similarly serious medical issue can be especially traumatic. Attorney Scott Glovsky is the advocate you need in your corner following a brain cancer insurance denial. Scott worked for big insurance companies early in his career, so he knows nearly every trick they may use to deny claims – and how to turn a denial into an approval.   

What Are Some of the Most Common Brain Cancer Treatments?

The primary types of glioma brain tumors include: Astrocytoma, glioblastoma, oligodendroglioma, and ependymoma. Gliomas can be benign but are more often malignant. Glioblastomas are the most common type of malignant brain tumor. Other types of brain tumors include choroid plexus tumors, embryonal tumors (medulloblastoma), germ cell tumors, pineal tumors (pineoblastoma), meningiomas, nerve tumors (acoustic neuroma), and pituitary tumors (craniopharyngioma). 

Brain tumors that are not cancerous tend to cause symptoms that develop slowly, with symptoms worsening over months or years. Cancerous brain tumors usually cause symptoms that worsen quickly. Symptoms come on suddenly and get worse over a matter of days or weeks. While the treatment for brain cancer will depend on the type and stage of the brain cancer, surgery, radiation, and chemotherapy are standard treatments. The surgery for brain cancer is known as a craniotomy. 

TomoTherapy is a type of therapy in which radiation is aimed at the tumor from many different directions as the patient lies on a table and is moved through a donut-shaped machine. The radiation source rotates around the patient in a spiral pattern. The cost of TomoTherapy in the United States is more than $20,000. 

Voranigo is a relatively new treatment medication for brain cancer that gained FDA approval in August 2024. Many brain cancer medications are expensive, which is the primary reason some insurance companies will deny these medications. Voranigo, for example, costs about $21,297 for 30 10 mg tablets. 

Brain cancers are also treated with immunotherapy, which is a treatment that takes advantage of a person’s own immune system to help kill cancer cells. The FDA-approved immunotherapy options for brain cancers currently include:

• Jemperli
• Keytruda
• Avastin
• Unituxin
• Danyelza

There are currently several other immunotherapy treatments being used to treat brain cancer that are in the clinical trial phase. Like Voranigo, these immunotherapy treatments can cost thousands of dollars, making it much more likely that an insurance company will deny the treatment, even when a doctor feels the treatment could save a life. 

Reasons Why Brain Cancer Treatments Might Be Denied

The primary reason that a brain cancer treatment – or any medical treatment – might be denied often comes down to money. Of course, in some cases, treatment might be denied simply because there was insufficient information on the claim or there were errors in the claim. These are issues that can be easily corrected, and the claim resubmitted. 

Sometimes, a claim is denied because the insurer specifically excludes the treatment, there was no prior authorization, or the treatment provider was not in-network. Often, however, medical treatments are denied because they are expensive. Insurance companies use terms like “not medically necessary,” “experimental,” or “investigational” in insurance denials, but insurers generally work hard to keep from paying for a more expensive medical treatment. 

What Should You Do if You Receive a Denial for Brain Cancer Treatment?

If you receive a brain cancer treatment insurance denial, you do have options. Attorney Scott Glovsky can help you explore these options and assist you in the appeal process. First, you might have your doctor write a letter to the insurance company that details why the specific brain cancer treatment is necessary. An internal appeal can be filed if the insurance company still refuses to pay for the treatment. 

An internal appeal asks the insurer to reconsider the original denial decision. If your case is urgent, you can file an expedited appeal, which means the insurer must provide a decision within 72 hours. An external appeal can be filed if the internal appeal still results in a denial. An independent review organization will review the claim during an external appeal and make a final decision. We recommend that you speak with an experienced health insurance denial attorney prior to an external appeal because depending on your specific insurance plan, you may be advised to take legal action instead.

Which Insurance Companies Are More Likely to Deny Brain Cancer Treatments?

While any insurance company may deny a medical treatment or procedure, some tend to be more likely than others to do so. Californians may receive denials of treatment or procedures from the following insurers:

• Anthem Blue Cross
• Blue Shield
• Health Net
• Kaiser
• Cigna
• Aetna
• Medi-Cal Managed Care Plans (Anthem Blue Cross, Promise Health Plan, Health Net, Molina)

Regardless of which insurer issues your brain cancer treatment insurance denial, Attorney Scott Glovsky will fight for your right to obtain the medical treatments your doctor believes you need. 

How the Law Offices of Scott Glovsky Can Help Those Whose Brain Cancer Treatment is Denied by Insurance 

If your insurance company has issued a brain cancer treatment insurance denial, you may feel helpless and hopeless. If so, you are right where your insurance company wants you. People who feel helpless rarely file appeals; they simply accept the decision as final. Since the treatment your doctor prescribes for your brain cancer could potentially mean the difference between life and death, it is essential that you speak to an attorney like Scott Glovsky, who has spent decades fighting insurance companies to ensure they honor their commitments. Scott will not allow an insurance company to place its financial bottom line over your medical well-being. Contact the Law Offices of Scott Glovsky today to get the help you need and deserve.