Conditions
Conditions & Insurance Denials
Insurance denials vary by condition. Find your condition below to understand common denial reasons, step therapy requirements, evidence checklists, and how to appeal effectively.
CIDP (Chronic Inflammatory Demyelinating Polyneuropathy)
Affects approximately 1–9 per 100,000 people in the U.S.
CIDP is a rare neurological disorder that causes progressive weakness and impaired sensory function in the legs and arms. It occurs when the immune system attacks the myelin sheath protecting nerves, leading to numbness, tingling, and difficulty walking. Treatment typically involves IVIG, subcutaneous immunoglobulin, or corticosteroids.
Myasthenia Gravis
Affects approximately 14–20 per 100,000 people in the U.S.
Myasthenia gravis is an autoimmune neuromuscular disorder that causes weakness in the skeletal muscles. It occurs when antibodies block or destroy acetylcholine receptors at the junction between the nerve and muscle. Symptoms include drooping eyelids, double vision, difficulty swallowing, and muscle fatigue that worsens with activity.
PIDD / CVID (Primary Immunodeficiency)
CVID affects approximately 1 in 25,000 people; PIDD overall affects ~1 in 1,200
Primary immunodeficiency diseases (PIDD) are a group of over 400 disorders where part of the immune system is missing or doesn't function properly. CVID (Common Variable Immunodeficiency) is the most frequently diagnosed form, causing low antibody levels and recurrent infections. Lifelong immunoglobulin replacement therapy is the standard of care.
MMN (Multifocal Motor Neuropathy)
Affects approximately 1–2 per 100,000 people in the U.S.
Multifocal motor neuropathy is a rare condition affecting the peripheral nerves that control muscle movement. Unlike CIDP, MMN causes progressive, asymmetric weakness without significant sensory loss. IVIG is the only proven treatment — corticosteroids and plasma exchange are ineffective and may worsen the disease.
Kawasaki Disease
Affects approximately 19 per 100,000 children under age 5 annually in the U.S.
Kawasaki disease is an acute illness primarily affecting children under 5 that causes inflammation in blood vessels throughout the body, particularly the coronary arteries. Without treatment, up to 25% of affected children develop coronary artery aneurysms. High-dose IVIG given within 10 days of fever onset is the standard of care and dramatically reduces cardiac complications.
ITP (Immune Thrombocytopenia)
Affects approximately 3.3 per 100,000 adults annually in the U.S.
Immune thrombocytopenia (ITP) is an autoimmune condition where the body's immune system destroys its own platelets, leading to dangerously low platelet counts and increased bleeding risk. Symptoms range from easy bruising and petechiae to life-threatening hemorrhage. Treatment aims to raise platelet counts to safe levels.
Lupus / SLE (Systemic Lupus Erythematosus)
Affects approximately 200,000–300,000 people in the U.S.; 9 out of 10 are women
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect virtually any organ system, including the skin, joints, kidneys, brain, and blood. Lupus causes the immune system to attack healthy tissue, leading to inflammation, pain, and organ damage. The disease disproportionately affects women, particularly women of color.
Multiple Sclerosis (MS)
Affects approximately 1 million people in the U.S.
Multiple sclerosis is a chronic autoimmune disease of the central nervous system where the immune system attacks the myelin sheath surrounding nerve fibers. This causes communication problems between the brain and body, leading to vision problems, muscle weakness, coordination difficulties, and cognitive changes. Early and aggressive treatment can slow disability progression.
Rheumatoid Arthritis
Affects approximately 1.3 million adults in the U.S.
Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily attacks the joints, causing painful swelling, stiffness, and progressive joint damage. Unlike osteoarthritis, RA is caused by the immune system mistakenly attacking joint tissue. Without treatment, RA can cause permanent joint deformity and disability.
Crohn's Disease
Affects approximately 780,000 people in the U.S.
Crohn's disease is a chronic inflammatory bowel disease (IBD) that can affect any part of the digestive tract, from mouth to anus. It causes inflammation that extends deep into the intestinal wall, leading to abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition. Crohn's disease can lead to serious complications including strictures, fistulas, and bowel obstruction.
Ulcerative Colitis
Affects approximately 900,000 people in the U.S.
Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that causes inflammation and ulcers in the innermost lining of the large intestine and rectum. Unlike Crohn's, it affects only the colon. Symptoms include bloody diarrhea, abdominal pain, urgency, and fatigue. Severe cases can lead to toxic megacolon, a life-threatening emergency.
Psoriatic Arthritis
Affects approximately 30% of people with psoriasis — roughly 2.4 million people in the U.S.
Psoriatic arthritis (PsA) is a chronic inflammatory arthritis that occurs in people with psoriasis. It can affect any joint in the body and causes joint pain, stiffness, and swelling. PsA can also cause enthesitis (inflammation where tendons and ligaments attach to bone), dactylitis (sausage-like swelling of fingers and toes), and progressive joint damage if untreated.
Psoriasis
Affects approximately 7.5 million adults in the U.S.
Psoriasis is a chronic autoimmune skin condition that causes cells to build up rapidly on the surface of the skin, forming red, scaly patches that can be itchy and painful. Moderate-to-severe psoriasis significantly impacts quality of life and is associated with increased risk of cardiovascular disease, depression, and psoriatic arthritis.
Ankylosing Spondylitis
Affects approximately 0.2–0.5% of the U.S. population — roughly 600,000–1.6 million people
Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints, causing pain, stiffness, and progressive fusion of the vertebrae. It typically begins in early adulthood and can lead to a hunched-forward posture if untreated. AS is part of the broader category of axial spondyloarthritis.
Wet AMD (Age-Related Macular Degeneration)
Affects approximately 1.1 million people in the U.S.
Wet age-related macular degeneration is a leading cause of vision loss in people over 50. It occurs when abnormal blood vessels grow beneath the retina and leak fluid or blood, causing rapid damage to the macula — the part of the eye responsible for central vision. Without treatment, wet AMD can cause permanent, irreversible vision loss within weeks to months.
DME (Diabetic Macular Edema)
Affects approximately 750,000 people in the U.S.; risk increases with diabetes duration
Diabetic macular edema is a complication of diabetes that causes fluid to accumulate in the macula, the central part of the retina responsible for sharp, detailed vision. It is the most common cause of vision loss in people with diabetic retinopathy. Anti-VEGF injections are the standard of care and can stabilize or improve vision in most patients.
Transplant Rejection Prevention
Over 40,000 organ transplants performed annually in the U.S.; 200,000+ transplant recipients on active immunosuppression
After organ transplantation (kidney, liver, heart, lung), the immune system recognizes the new organ as foreign and attacks it. Immunosuppressive medications are essential to prevent rejection and protect the transplanted organ. Missing even a few doses can trigger rejection and organ loss. Lifelong immunosuppression is required for most transplant recipients.
GBS (Guillain-Barré Syndrome)
Affects approximately 1–2 per 100,000 people annually in the U.S.
Guillain-Barré syndrome is a rare but serious autoimmune disorder where the immune system attacks the peripheral nerves, causing rapid-onset muscle weakness that can progress to paralysis. GBS is a medical emergency — treatment with IVIG or plasma exchange must begin promptly to reduce the severity and duration of the illness. Most patients recover, but recovery can take months to years.
Pemphigus / Pemphigoid
Pemphigus affects approximately 0.5–3.2 per 100,000; pemphigoid affects 2.4–21.7 per 100,000
Pemphigus and pemphigoid are rare autoimmune blistering diseases of the skin and mucous membranes. In pemphigus, antibodies attack proteins that hold skin cells together, causing painful blisters and erosions. In pemphigoid, antibodies attack the layer between the epidermis and dermis. Both conditions can be debilitating and, without treatment, pemphigus can be life-threatening.
Stiff Person Syndrome
Affects approximately 1–2 per million people — one of the rarest autoimmune conditions
Stiff person syndrome (SPS) is an extremely rare autoimmune neurological disorder characterized by progressive muscle stiffness and painful spasms, primarily in the trunk and limbs. The condition is caused by antibodies against GAD65 (glutamic acid decarboxylase), which impair GABA-mediated inhibition of motor neurons. SPS can be severely disabling and is often misdiagnosed.
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