The family is fighting for insurance to approve the mother’s medication which is now being denied

WICHITA, Kan. (KWCH) – A Kansas family is fighting to get their mother the medicine they say she desperately needs.

The family called FactFinder after the insurance company denied her previously approved medication and has since left them paying more than $1,000 out of pocket.

Christina Novak used to live a healthy life, but her family said that changed after she had hernia surgery in the spring of last year. After the surgery, the family said Christina developed a condition called hyponatremia, which causes her to have low sodium levels. This condition makes him feel sick, depressed and ends up in the hospital. Although Novak is still struggling with his physical condition, his family is helping him fight with his insurance company to authorize the medication to treat his condition.

Novak’s daughter, Christa Gann, sat down with FactFinder to explain her family’s concerns.

“Helplessness is not the right word to describe how I feel, especially as a nurse,” Gann said.

Gann showed dozens of papers filled with summaries of her mother’s hospital visits and medical records over the past year and a half that she said are proof that her mother needs special medications to stay healthy. and from the emergency room.

“She couldn’t go a single day without some form of medical intervention,” said Gann about his mother’s condition without taking medication.

This drug is Tolvaptan. It was originally prescribed by doctors and Novak’s insurance, Blue Cross Blue Shield of Kansas, accepted last year. Since Aug. 2023 to Aug. In 2024, Novak took Tolvaptan and his family said his life returned to what it was before the surgery. That was until his prescription ran out and he tried to get more.

Gann told FactFinder BCBSKS denied his mother’s request for pre-service Tolvaptan. After filing the appeal, Novak received a letter from BCBSKS stating that the “consultant’s review of all available information confirmed the denial of Tolvaptan for the treatment of Hyponatremia.”

BCBSKS added that the decision was based on medical documentation and was a medical needs benefit decision only.

Although the insurance company acknowledged in the letter that Novak had previously been prescribed Tolvaptan, the letter states, “Tolvaptan packaging does not support long-term use as more than 30 days is not recommended for liver protection.”

Novak continued to appeal the decision, but while he was waiting for an answer and without medicine, his family said he ended up in the hospital sick. Gann says that’s when his mother was able to receive Tolvaptan.

“I feel bad about taking him to the emergency room for a non-narcotic, non-insulin medication,” Gann said. It’s just a special medicine that keeps his sodium from going down.

However, going to the hospital was only a temporary solution for Novak as he was released once his sodium levels stabilized. Gann told FactFinder that her mother’s doctor contacted her insurance and asked that the decision to deny the medication be reconsidered.

In a letter to BCBSKS, Novak’s doctor called the refusal “confusing and time-consuming” despite the office’s efforts to find an approved medication including peer discussion with the insurance company.

His doctor wrote in a letter that Tolvaptan “has proven to significantly improve his health, reduce the risk of complications, and reduce health care costs by reducing hospital admissions and emergency visits.”

The doctor also added that the long-term safety of the drug is well documented and the doctor’s office “is committed to following all safety regulations, including regular liver function tests, to ensure that Christina continues first to be healthy.”

That letter was sent last month to BCBSKS. The family says that until now, Novak is still waiting for an answer.

“Trust me, the insurance company, I don’t want his life to depend on this drug just as obviously you don’t want his life to depend on this drug,” Gann said.

While they wait, Novak’s family is paying out of pocket and traveling out of the country to get his medicine. A 30-day supply of Tolvaptan that a family recently took in Missouri cost them more than $1,900. They are trying to find ways to come up with the money to buy one month’s worth of medicine, but they say it is not a long-term solution.

Gann said: “The time is getting closer to the end of his medication.

FactFinder contacted BCBSKS to ask what action Novak should take in his case but has not heard back.

As for the family, they are working to help Christina meet with the Mayo Clinic to find a solution, so that she can live her life without relying on medication.

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