LADUE, MO. — Humana reversed its initial denial of payment for Margaret Hvatum's Hizentra treatments in late January 2025 after she appealed. The reversal followed Hvatum's hospitalization on January 30, which occurred after she missed doses of the medication due to Humana's prior refusal to cover the treatment under her Medicare Advantage plan.

Hvatum, a 70-year-old part-time computer science professor, has primary immunodeficiency, a condition diagnosed in 2005 that weakens her immune system. She uses Hizentra, an immune globulin product derived from donated blood plasma, to manage her condition. After Humana denied payment for Hizentra, Hvatum missed several weekly doses, leading to a urinary tract infection.

Hvatum went to the emergency department for the infection and stayed overnight in the hospital. The hospital charges for this stay exceeded $18,000. Humana initially denied payment for the hospital stay, asserting that Hvatum's condition did not warrant hospital care. Hvatum appealed this denial, and Humana subsequently reversed its decision.

The approval for Hizentra coverage will expire at the end of the year, requiring Hvatum to seek approval again. "I have done everything I possibly can to be healthy," Hvatum said.

Carrie Graham, director of the Medicare Policy Initiative at Georgetown University's Center on Health Insurance Reforms, stated that insurers "make a profit if the care that person receives in that year is less than the amount they receive." In 2024, Medicare Advantage plans reviewed nearly 53 million prior authorization requests, according to KFF. KFF also reported that 81% of Medicare Advantage appeals were partially or fully overturned in 2024. Roughly 35 million Medicare beneficiaries had Medicare Advantage coverage in 2026, and KFF indicated that nearly half of all Medicare Advantage enrollees nationwide are covered by UnitedHealth Group or Humana.

Humana and other large insurers signed a pledge last summer aimed at easing the burden of prior authorization for patients. Humana spokesperson Mark Taylor stated that this industry pledge applies specifically to medical services and not to prescription medications. In July 2025, Humana announced plans to remove one-third of its prior authorization requirements for outpatient services.