Latest news with #BlueShieldofKansas
Yahoo
02-05-2025
- Health
- Yahoo
Kansas college student wins appeal, insurance approves treatment
WICHITA, Kan. (KSNW) — An update on a story we brought you in March. Natalie Graves has Crohn's disease, a chronic inflammatory bowel disease. She was on a medical infusion treatment called Remicade. Instead, Blue Cross and Blue Shield of Kansas offered her two other options, Inflectra and Avsola. When she switched, she said her disease's symptoms flared up again. 'I had a colonoscopy on Thursday to assess the overall damage to what's going on, and they found that I have some erosions and ulcers caused by that biosimilar medication not being able to manage and control my Crohn's,' Graves said. Graves first received a denial letter early in 2024. After filing an appeal, which was also denied, her doctor attempted to contact her insurance company directly, but with no success in reversing the denial. Longtime Wichita chef receives life-saving liver transplant A viewer reached out to KSN last month and donated a month's worth of medication from their pharmacy in Tennessee to their doctor in Kansas City. Following that, Graves filed an appeal, and last week, learned that Blue Cross and Blue Shield of Kansas reversed the previous denial, approving her treatment until March 2026. She said she was shocked by how quickly things changed in her favor. 'So incredible, that within six weeks of a post being posted, and a news story, that my 12-month battle was shortened and ended just like that,' Graves said. KSN reached out to Blue Cross and Blue Shield of Kansas on Thursday, and in a statement, a representative said: 'Due to patient privacy, we are unable to provide specifics about an individual or case. Prescription drug costs are a main driver of rising healthcare costs. We are committed to controlling costs for our members. Our policy supports the use of biosimilar drugs when possible as they are safe, effective, and expected to have similar results at a significantly lower cost.' For more Kansas news, click here. Keep up with the latest breaking news by downloading our mobile app and signing up for our news email alerts. Sign up for our Storm Track 3 Weather app by clicking here. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
13-03-2025
- Health
- Yahoo
‘My health is in jeopardy': Insurance denies Kansas nursing student's prescription
WICHITA, Kan. (KSNW) — A college student from Anthony is speaking out after Blue Cross and Blue Shield of Kansas denied a medicine she has been using successfully for years. Natalie Graves has Crohn's disease, a chronic inflammatory bowel disease. She was on a medical infusion treatment called Remicade. Instead, Blue Cross and Blue Shield of Kansas offered her two other options, Inflectra and Avsola. When she switched, she said her disease's symptoms flared up again. 'I had a colonoscopy on Thursday to assess the overall damage of what's going on, and they found that I have some erosions and ulcers caused by that biosimilar medication not being able to manage and control my Chron's,' Graves said. Graves first received a denial letter early in 2024. After filing an appeal, which was also denied, her doctor tried contacting her insurance company personally, with no success in getting the denial reversed. Graves, whose parents have been policyholders with Blue Cross and Blue Shield of Kansas for 26 years, said she feels like a test subject. 'It is really frustrating. I'm not a guinea pig. I'm a human being. I'm not just a policyholder. I'm a patient who has a life to live,' Graves said. 'A change needs to be made.' A spokesperson for Blue Cross and Blue Shield of Kansas declined to go on camera for an interview but provided the following statement: We are committed to controlling costs for our members. Biosimilars are products highly similar to other biologics that are FDA-approved. Our policy is to use biosimilar drugs when possible as they are equally safe, effective and expected to have the same results at a significantly lower cost. Members who do not tolerate a specific prescription drug have several alternatives. These alternatives include other medications, as well as an appeal process which includes an external review. Members may also be eligible to have their provider submit a reconsideration request. Members with questions about their appeal process are encouraged to call the customer service number on the back of their card.' Blue Cross and Blue Shield of Kansas In the field of gastroenterology, for more than 40 years, Dr. Mark Allen said he has seen dozens of patients denied coverage by their insurance company. He believes it impacts doctors' ability to treat patients nationwide. He spoke in Topeka to support House Bill 2157, which would have established restrictions on step-therapy protocols used by insurance companies when approving prescriptions. It ultimately failed in committee in 2022. 'All gastroenterologists have faced increasing problems with insurance-mandated switching to different drugs,' Dr. Allen said. 31 million Americans borrowed money for health care last year: Poll He said not every person responds to each medicine the same, which is why treatment must be individualized. 'Involve any part of the GI tract. Therefore, the treatment options have to be tailored to that specific patient. Switching drugs is not always in the best interest of the patient,' Dr. Allen said. Graves wants answers, but more importantly, to be placed back on the drug that was working. 'That's completely outrageous and so upsetting. It's not just my life being affected. It's so many other people. Our hands are tied. I have no control over my own health; my own doctor doesn't even have control over my own health,' she said. KSN asked Blue Cross and Blue Shield of Kansas' representatives how many policyholders have been denied from their preferred treatment and how their appeals process works. The insurance company did not respond to a specific list of questions. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
