Answers: "My Insurance Company Is Denying My Hepatitis C Treatment"
Last updated: July 2023
With today's new and improved medicines, hepatitis C treatment is better than ever. Most patients can be cured in as little 8 to 12 weeks. Unfortunately, however, hep C treatment can be expensive, and many insurance companies deny patients treatment or refuse to cover the cost of treatment.
To better serve our community, we asked our HepatitisC.net advocates, "What advice would you give someone who says “My insurance company is denying my hepatitis C treatment?" Here is their advice to patients who might be struggling:
"Ask your doctor to file an appeal. If they continue to deny treatment, ask your doctor if you are eligible to switch to a different treatment and file again. With the new generic treatments for hep C available in the US, we are seeing this process approved more often."
Where are you in your treatment journey?
"Ask for a written explanation that articulates the reason for the denial. Once received, if the explanation seems unreasonable, contact a hep C advocate organization and ask them to review the response and what avenues they recommend you take to challenge the determination. For example, you could contact the Hep C Alliance. If you have the resources, this issue could also be brought to the attention of a lawyer who specializes in insurance claims."
"I didn’t have insurance when my doctor first approved me for hepatitis C treatment. I learned that if someone doesn’t have insurance, they can still get treatment. My nurse practitioner told me that she would handle the paperwork, and that got everything rolling. At my next appointment, I learned that there was a pharmaceutical program to help with the costs of hepatitis C treatment. Even if you don’t have the money, never give up. You can get treatment."
"Persist with insurance billing at the doctor's office to continue to resend the request for treatment. It can take several attempts to continually request treatment. In my experience, I have seen patients need to keep resending requests in until it is approved."
"In this situation, the first thing to do is contact the office of the doctor who is prescribing your hepatitis C treatment. Let the receptionist know that you need to speak with whoever handles insurance issues in the office. Let this dedicated insurance person know that your hepatitis C treatment is being denied by your insurance and see if they can assist you with submitting an appeal to your insurance company. Another possible option is to see if they can ask your doctor to contact your insurance company to request a peer-to-peer review with the medical director of your insurance company. The purpose of a peer-to-peer review is for your doctor to advocate for your need for treatment to the insurance company."
"Depending on where you live, there are options for publicly or pharmaceutical-funded treatment. The key is not to give up! Most often, your hepatitis C team will have resources to guide you through funding. Each state has a different program. For example, if you live in New York, the Department of Health, through the HepCAP program, provides hep C medical care at no charge."
"You have the right to appeal the decision your insurance company made. If that doesn't work, take a look at our Resources Page. You may also consider calling Help-4-Hep at 877-435-7443. The call and help are free. They are often successful in helping patients access care."