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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Personal Injury Law
Satisfied Customers: 111450
Experience:  Licensed Attorney. Over 20 years experience in personal injury and law enforcement.
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I was taking HUMIRA injections weekly for severe Psoriatic

Customer Question

I was taking HUMIRA injections weekly for severe Psoriatic Arthritis for over 3 years and now my insurance is denying the weekly use(the same insurance that had approved the HUMIRA)This is causing me severe pain and my Psoriasis HAS RETURNED,CAUSING ME TO NOT ONLY HURT BUT BE EMBARASSED TO BE IN PUBLIC!CAN I SUE THE INSURANCE COMPANY?
JA: What state are you in? It matters because laws vary by location.
Customer: PA.
JA: Has anything been filed or reported?
Customer: NO,THE ONLY THING THAT HAS HAPPENED IS THAT MY DOCTOR FILED AN APPEAL THAT WAS DENIED AND NOW THE DOCTOR IS TRYING TO GET A DIFFERENT MEDICATION APPROVED.IN THE MEAN TIME I HAVE TO GO WITH OUT ANY ARTHRITIS MEDICATION
JA: Anything else you want the lawyer to know before I connect you?
Customer: NO THAT IS ALL I HAVE
Submitted: 1 month ago.
Category: Personal Injury Law
Expert:  Law Educator, Esq. replied 1 month ago.
Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.
You need to file your third level appeal to the independent review and if that is denied, then your next step is you need to file suit against the insurer for breach of contract. If they have been covering the medication all this time and now have changed the medication approval on you, these are the steps you need to take to force them to re-approve it for you.

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