LADUE, MO. — Margaret Hvatum, a 70-year-old part-time computer science professor, was hospitalized in January 2026 after Humana denied coverage for her immune system medication. She visited the emergency room on Jan. 30, 2026, which resulted in an overnight hospital stay and charges exceeding $18,000.

Hvatum, who has primary immunodeficiency, a condition diagnosed in 2005 that weakens the immune system, relies on Hizentra for treatment. The medication is derived from antibodies sourced from donated blood plasma. The full cost for a 28-day supply of Hizentra without insurance is $8,141.94.

Hvatum switched Medicare Advantage plans at the beginning of January 2026. Humana denied her prior authorization request for Hizentra that month. As a result, she missed several weekly doses of her medication.

Hvatum developed a urinary tract infection and went to the emergency room, incurring hospital charges of more than $18,000. Humana subsequently denied payment for her hospital care, stating she was not sick enough to require it. Hvatum appealed the denial, and Humana reversed its initial payment denial for Hizentra in late January 2026. The approval for Hizentra coverage is set to expire at the end of 2026.

Margaret Hvatum stated, "I have done everything I possibly can to be healthy." Humana spokesperson Mark Taylor said the insurer "builds important checks and balances into the healthcare system by verifying that treatments and care delivery are in the best interest of patient safety and quality of care, while safeguarding taxpayer dollars." He also stated, "We are committed to making the process faster and more seamless for patients and providers."

Last summer, Humana joined other major insurers in signing a pledge to reduce the burden of prior authorization for patients. However, Taylor clarified that this pledge applies only to medical services and not to prescription medications. In July 2025, Humana announced it would eliminate one-third of prior authorization requirements for outpatient services. Carrie Graham, director of the Medicare Policy Initiative at Georgetown University's Center on Health Insurance Reforms, said, "They make a profit if the care that person receives in that year is less than the amount they receive."

This situation illustrates the challenges individuals can face when health insurance coverage changes, particularly for those with chronic conditions requiring consistent medication. Delays in medication approval can lead to health complications and large medical expenses. Humana's stated commitment to streamlining processes for patients and providers contrasts with the specific denial of prescription medication coverage that led to Hvatum's hospitalization.

The case also highlights the financial aspects of Medicare Advantage plans, where insurers can profit when healthcare expenditures for enrollees are lower than the premiums received. Appeals within Medicare Advantage plans can be effective, with 81% of appeals in 2024 being partially or fully overturned.