Yescarta Insurance Denial

Page Contents:

• Why Might You Receive a Yescarta Insurance Denial?
• What Should You Do for Yescarta Denied by Insurance?
• What Specific Insurance Companies Are Known to Deny Treatments?
• What Illness Is Yescarta Used to Treat?
• When Was Yescarta Approved by the FDA for Treatment of B-cell Lymphoma?
• How the Law Offices of Scott Glovsky Can Help with a Yescarta Insurance Denial

Why Might You Receive a Yescarta Insurance Denial?

Yescarta is used to treat large B-cell lymphoma, which is a type of non-Hodgkin lymphoma. Yescarta is used in patients whose cancer returned within a year of the first treatment or when the first type of cancer treatment was unsuccessful. Yescarta is different from many other cancer medications because it is formulated from the patient’s own white blood cells. These white blood cells are modified to recognize and attack lymphoma cancer in the body. While you could receive a Yescarta insurance denial for many different reasons, some of those reasons are easy to fix, while others are not.

If your denial letter states there were errors or omissions or the medication was miscoded, then these issues can likely be corrected. In some cases, your insurance policy may specifically exclude Yescarta and similar drugs or may require prior authorization. If, however, your insurer says the denial is due to the drug being “experimental,” “investigational,” or “not medically necessary,” it is often likely the real reason is because the drug is expensive.

Insurance companies are primarily interested in their financial bottom lines, and they know that most people will not appeal an insurance denial. For Yescarta denied by insurance, you need a strong advocate in your corner. Attorney Scott Glovsky is that advocate. Scott and his highly skilled legal team will fight for you and your future, never hesitating to go up against a big insurance company and force it to honor the commitment made to you.

What Should You Do for Yescarta Denied by Insurance?

If you have received a Yescarta insurance denial, you will need to file an appeal. There are two types of appeals—internal and external. You begin with an internal appeal that asks your insurer to look at the denial again and make a different decision. An internal appeal can benefit from a letter from your doctor detailing all the reasons you would benefit from Yescarta. If this internal appeal results in the same decision from your insurer—a denial—then you can file an external appeal with a neutral third party.

The decision of this external appeal is binding on your insurer. Because it is binding, it is ideal to speak with an experienced health insurance denial attorney before you file an external appeal. Attorney Scott Glovsky understands how difficult it can be to go through the appeal process on your own, especially when you are not feeling your best and are anxious about your health and your future. Scott has been helping people in the same situation for many, many years, and could be your best option for a positive outcome.

What Specific Insurance Companies Are Known to Deny Treatments?

While any insurance company may deny a treatment—especially when the treatment is more expensive—some insurers are more likely to do so. The following California health insurance companies may deny Yescarta treatment to those who need the medication:

• Anthem Blue Cross
• Blue Shield
• Health Net
• Kaiser
• UnitedHealthcare
• Aetna
• and others

What Illness Is Yescarta Used to Treat?

Currently, Yescarta is used to treat the following diseases:

• Adult patients with diffuse large B cell lymphoma (DLBCL) or high-grade B-cell lymphoma (HGBL) that has recurred within 12 months of “traditional” treatments, or has not responded to traditional treatments
• Adult patients with primary mediastinal large B cell lymphoma (PMBCL) following two or more lines of systemic therapy
• Adult patients with r/r follicular lymphoma (FL) who have already undergone three or more lines of systemic therapy

When Was Yescarta Approved by the FDA for Treatment of B-cell Lymphoma?

Yescarta gained FDA approval on April 1, 2022. This approval was based on a multi-center trial among adult patients (ZUMA-7). This trial showed that survival rates were positively impacted among patients who were given Yescarta, with an 18-month survival rate of more than 41 percent. Unfortunately, Yescarta is an expensive treatment, triggering many Yescarta insurance denials. Yescarta was initially priced at $373,000, but since it was introduced, Gilead has increased the price by more than $50,000, which is almost twice what the treatment costs in Japan.

How the Law Offices of Scott Glovsky Can Help with a Yescarta Insurance Denial

If you or a loved one has received a Yescarta insurance denial, it can be extremely disheartening. During an already difficult time, Yescarta getting denied by your insurance when your doctor believes it could significantly help you, can feel entirely overwhelming. This is a time when you could significantly benefit from speaking to attorney Scott Glovsky. The Law Offices of Scott Glovsky is truly different from other law firms.

Scott formerly worked in large corporate law firms defending insurance companies, so he fully understands how insurers think and operate and can stay a step ahead of their legal strategies. Attorney Scott Glovsky has a solid reputation in the industry, is well-respected, and is known for personal, caring client attention.

Scott purposely takes fewer cases, allowing him to devote the necessary time and care to each client. There is no “assembly line” feel to the Law Offices of Scott Glovsky—we get to know our clients, their families, and the story behind their suffering. Our highly successful track record can give you peace of mind when you turn your Yescarta insurance denial over to attorney Scott Glovsky. Contact the Law Offices of Scott Glovsky today.