Lymphoma Treatment Insurance Denial

Legally reviewed by Scott Glovsky , Trial Attorney & Founder

According to the Lymphoma Research Foundation, lymphoma is the most common type of blood cancer among adults and the third most common type of cancer overall among children. Every year across the United States, more than 100,000 individuals across the nation will be diagnosed with lymphoma. The five-year survival rate for Non-Hodgkin’s Lymphoma is 74 percent, although these rates vary significantly according to the stage and subtype of the lymphoma, the individual’s age and general health, and whether the individual receives appropriate treatment.

Unfortunately, all too often we see lymphoma treatment denied by insurance. If you or a loved one should find yourself in such an untenable position, you need a strong advocate in your corner—someone who will fight for you, your health, and your future. It can be rare to find an attorney who truly cares about you and your family, but attorney Scott Glovsky is different—compassionate, trustworthy, and tough.

Page Contents:

• Why Might a Lymphoma Treatment Be Denied by Insurance?
• Specific Types of Lymphoma Treatment That Might Be Denied
• What Should You Do if Your Lymphoma Treatment Is Denied by Insurance?
• What Insurance Companies Are More Likely to Deny Lymphoma Treatments?
• Which Lymphoma Treatments are Most Likely to Be Denied by Your Insurer?
• How Do You Prove Your Lymphoma Treatment is Medically Necessary?
• How the Law Offices of Scott Glovsky Can Help When Your Lymphoma Treatment is Denied by Insurance

Why Might a Lymphoma Treatment Be Denied by Insurance?

There are many reasons medical treatment could be denied by insurance. In some cases, it is something as simple as an improperly filled-out form, which can be easily fixed. Your insurer may claim that the lymphoma treatment was denied because it is not covered under your plan, or that you failed to obtain necessary pre-authorization. Other times, an insurer may refuse to cover a lymphoma treatment simply because it doesn’t want to pay for the treatment—no matter how much you need it.

These denials are usually hidden behind language like “not medically necessary,” “experimental,” or “investigational.” These are the difficult lymphoma treatments denied by insurance that attorney Scott Glovsky can help you with. There are avenues for those who have had a necessary medical treatment denied by insurance. Don’t face the complexities of these solutions alone—call the Law Offices of Scott Glovsky.

Specific Types of Lymphoma Treatment That Might Be Denied

Some of the most common types of lymphoma treatments include:

Chemotherapy uses IV drugs or pills to destroy fast-growing cancer cells.

Radiation therapy uses X-rays and proton beams of energy to kill cancer cells.

Bone marrow transplants, also known as stem cell transplants, involve high doses of radiation and chemotherapy to suppress the bone marrow, followed by infusions of healthy bone marrow stem cells that will travel to the bones and begin rebuilding healthy bone marrow.

Targeted drugs focus on cancer cell abnormalities. One of these drugs is Jaypirca, used to treat adults with recurring or non-responsive mantle cell lymphoma. Jaypirca and drugs like it contain a BTK inhibitor. Another is Polivy, used in combination with Rituxan for those newly diagnosed with large B-cell lymphoma.

Immunotherapy drugs work with the immune system to kill cancer cells. These drugs include:

• Keytruda
• Rituximab
• Gazyva
• Arzerra
• Zevalin

Chimeric antigen receptor (CAR) T-cell therapy removes germ-fighting T-cells from the body, engineers them to fight the lymphoma, then they are infused back into the body.

Learn More

What Should You Do if Your Lymphoma Treatment Is Denied by Insurance?

Lymphoma treatment denied by insurance can be extremely distressing. At a time when you are already sick, wanting nothing more than to focus on getting better, you are forced to literally fight for your life with the insurance company. You don’t have to go through this alone! While you can handle your own appeals—both internal and external—you have a much better chance of success when you have an experienced insurance denial attorney like Scott Glovsky working on your behalf. First, you will need to ask your doctor for a detailed letter that states exactly why this particular treatment is medically necessary. Your attorney will then provide guidance for you to file an internal appeal, asking the insurer to reconsider its initial decision.

If the insurance company still denies the lymphoma treatment you need, your attorney may recommend that you file an external appeal with a third party. This takes the decision out of the hands of the insurance company and gives you a chance of getting your necessary lymphoma treatment approved. Many appeals result in a reversal of the insurer’s initial decision, so you have virtually nothing to lose and everything to gain by speaking to the Law Offices of Scott Glovsky regarding a lymphoma treatment denial.

What Insurance Companies Are More Likely to Deny Lymphoma Treatments?

While any insurance company can deny your lymphoma treatment, some are more likely to do so than others. In 2019, according to CNN, a federal judge blasted UnitedHealthcare for its “immoral and barbaric” denials of treatments for cancer patients. California insurance companies that could potentially deny your lymphoma treatments include:

• Anthem Blue Cross
• Blue Shield
• Health Net
• Kaiser
• United Healthcare
• Aetna

Which Lymphoma Treatments are Most Likely to Be Denied by Your Insurer?

Generally speaking, the lymphoma treatments most likely to be denied by insurance companies are those that cost the most money. Some of these include:

• Polivy, used for Diffuse Large B-Cell Lymphoma, costs approximately $3,744 per injection.
• Keytruda costs about $12,500 per month
• Gazyva costs about $41,300 for six months
• Arzerra costs almost $2,000 per injection
• Jaypirca costs about $7,381 per month

How Do You Prove Your Lymphoma Treatment is Medically Necessary?

Your health insurer will provide its own definition of “medically necessary” in your policy, although there may also be a definition under California state law. Medical necessity may be proven through a Letter of Medical Necessity provided by your doctor. This can be done prior to the treatment, during the treatment, or after you find out the treatment will not be covered. This letter will detail why you need this specific treatment, plus your doctor may detail the history of the treatment to show it is neither experimental nor investigational.

How the Law Offices of Scott Glovsky Can Help When Your Lymphoma Treatment is Denied by Insurance

A lymphoma treatment denied by insurance can feel like the end of the world. Attorney Scott Glovsky is here to fight for you, convincing the insurance company to reverse its decision and approve your lymphoma treatment. The Law Offices of Scott Glovsky is truly different than other law firms. Scott formerly worked in large corporate law firms defending insurance companies, so he knows exactly how they think and operate. This allows us to stay one step ahead of the insurance company. Our firm is highly respected by others in the industry as well as by our clients who receive extremely personal and caring client attention. Contact the Law Offices of Scott Glovsky today.

“As a young lawyer, I am appreciative of great lawyers like yourself, who are willing to take the time to pass your knowledge and wisdom onto others.  I just finished your podcast with Greg Reeves.  I grew up with Greg’s niece, and his brother built my childhood home.  I had no idea how great of a lawyer he was until recently.  I started following him on Instagram after I graduated law school, and he is the reason I was led to your podcast a few months ago and to Gerry Spence’s book “Win Your Case”.

I hope to be able to attend the Ranch and effectively incorporate the techniques you discuss in one of the coming years. I hope you are able to keep the podcast going, and I look forward to each episode.

Thank you for sharing your gift with us.”

- J.F.B