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What Can You Do To Appeal An Insurance Denial Of Hepatitis C Treatment?

What Can You Do To Appeal An Insurance Denial Of Hepatitis C Treatment?

I Just Got Diagnosed With Hepatitis C, What Do I Do Now?

The initial diagnosis of hepatitis C can be overwhelming and stressful for many patients. They may be wondering where the virus came from, how long they have had it, whether they have caused infection to others, and what damage their body has experienced. In these first moments, it is important to focus on education. The doctor will answer questions and may provide written materials or a website where information about the virus may be found.

In addition, the doctor will want to discuss treatment options with the patient right away. During this time, the doctor and patient will discuss the patient’s specific type of hepatitis C virus (called the genotype), as well as any other medical concerns or issues that might narrow down treatment options. These may include allergies, the patient’s weight, any other medications the patient is taking, and other aspects of the patient’s medical history. The doctor and patient will also discuss what options are covered by the patient’s insurance, if they have insurance. There may be a known answer during this conversation or there may need to be phone calls to the insurance company before an answer is known.

If you are the patient, you can ask the doctor about what they recommend you do, as the insured, in order to obtain all information necessary to move forward with treatment with as little cost to you as possible.

I Am Afraid to Apply For Fear of Denial.

However you feel is completely okay, however waiting to begin treatment is not advisable since the virus can continue to cause damage to the body until it is treated, so the insurance approval process is something every patient must do in order to have their treatment covered. You may be able to ask your doctor about your concerns as some may be easy for them to respond to. Otherwise, you can always call your insurance company (look on the back of your insurance card or on their website for the contact information). You may discover that this process is quite easy or you may find that it can be made easier by following their steps or answering some additional questions.

I Have Been Denied, Now What?

As many as 25% of all patients are denied for hepatitis C treatment the first time they submit the insurance paperwork. If you have been denied treatment for any reason, the insurance company will send an EOB (explanation of benefits). This document will tell you why the insurance company is refusing to cover your medical needs. If you do not understand the document, do not worry or feel embarrassed, the medical language may be tricky. You can always call your insurance company to ask them to explain it to you or you can talk with your doctor’s billing department. You may discover that a wrong code was entered or a typo occurred and you’ll simply need to ask the billing department to correct the error and resubmit the paperwork. You may find that the insurance company cannot cover the costs of your treatment until you reach a specific deductible, which is the amount you need to pay before the insurance begins to pay. In this case, your insurance company can tell you the amount and what happens after you reach that number. If you cannot afford this, your doctor may be able to recommend a financial assistance program or low income clinic that can begin your treatment at a rate you can afford.

In some cases, the denial is based on the specific drug chosen for treatment. The insurance company may find that this is an expensive drug and a less expensive option is just as good for your needs. If this is the case, your doctor can discuss this with you and you can either agree to this treatment plan or your doctor can file an appeal with your insurance company. This typically occurs when the more expensive drug is a better fit because of the patient’s specific needs, such as an ingredient in the cheaper drug causes an allergy for the patient and that ingredient is not in the more expensive drug.

If you were denied because your insurance company does not think you are sick enough to need the treatment (which is typically very expensive), you can discuss this with your doctor. Some doctors will have the patient monitored until they reach the very beginning of an increased infection so that the insurance company can be satisfied without causing any more harm to the patient than necessary. Others will write an appeal letter to the insurance company outlining the medical risks of waiting to begin treatment. Whatever your needs, your doctor can help you to get your medical treatment approved or help to direct you to someone who can.1-4

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Abram, S. (2015). Woman sues Anthem Blue Cross for denying hepatitis C drug Harvoni. Retrieved 23 March 2017, from
  2. Bergthold, L. (2011). Health Insurance Claim Denied? Don't Despair. Fight Back.. The Huffington Post. Retrieved 23 March 2017, from
  3. Krans, B. (2015). One-Fourth of Hepatitis C Patients Initially Denied Life-Saving Treatment. Healthline. Retrieved 23 March 2017, from
  4. Salzman, S. (2015). How insurance providers deny hepatitis C patients lifesaving drugs. Retrieved 23 March 2017, from