Medicare, Medicaid, Life and Health Insurance/Midwest Medicaid Coverage


My daughter has Lupus and has for 21 years.  2 years ago the FDA approved Benlysta for treatment of Lupus.  This is the ONLY medicine that has EVER been approved to treat Lupus.  All other medicines teat only the symptoms.  Midwest Medicaid refuses to cover this treatment.  I need someone to explain to me HOW this can be allowed!  If there were only one medicine for Diabetes or Cancer would they be allowed to not cover the cost?  I want to know why my daughter will be allowed to die.  Someone needs to explain this to me.  Glaxo-Kline-Smith will cover 50% if her insurance will cover the other 50%, but she has been refused by Midwest Medicaid.  I am looking for answers.

Thank you,
Desperate Mother

Hi Jill-----

Medicaid is a state funded government program that has can always appeal their denial decision.

Since each state has its own rules and guidelines you need to go on to their website or call them to see how they handle appeals.  Then send an can usually do two appeals.
Usually appeals go to different people than the first denial.

All insurance carriers have exclusions and unfortunately if they list a drug or procedure as an exclusion they do not have to pay.  

If you get no where with the appeals you can always get your Senator involved or perhaps even the local news.  This always seems to get someone's attention.

Good Luck!

Medicare, Medicaid, Life and Health Insurance

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Has your medical insurance company denied your claim and refuses to pay? Have you received a pre-authorization and still your insurance company refuses to pay? How can you get your insurance company to reverse a denied claim? How do you get a provider to waive your copayment if you are financially unable to pay? Can a provider sue you for a unpaid bill and will they? Can a provider send me to a collection agency for a medical bill? If my insurance company does not pay, am I responsible? If you have these questions or others on why your insurance company is not paying your bills, I can help. I can give you "tricks of the trade" to get your insurance company to pay. I have limited knowledge on Medicare and Medicaid and that is not my expertise. Each state is very different regarding Medicare and Medicaid so you need to review their website when you have questions. So please no Medicare or Medicaid questions!!


In the medical field for over 20 years spending majority of time in the collections aspect.

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