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Tips if Hepatitis C Treatment was Denied

What do you do if your  insurance denies hepatitis C treatment ?

What do you do if your insurance denies hepatitis C treatment?

Recently, I received a few messages from people with hepatitis C, stating they were denied treatment by their insurance companies. The denials were because their insurance companies wouldn’t treat early stages of fibrosis.

I asked when they were denied, and they told me it was in 2015. Fortunately, I was able to tell some people that their insurance companies changed their guidelines, and some are treating all fibrosis levels, even stage 0.

At the end of this blog, I provide links to some of the insurance companies’ latest hepatitis C treatment criteria. However, even if your insurer hasn’t changed, there is still plenty that you can do in the face of insurance and Medicaid restrictions:

  • Get help. Work with a patient assistance program. HepMag.com has a list of programs. One of my favorites is the Hepatitis C Careline. You can also call Help4Hep and ask them for assistance: 877 Help 4 Hep (877 435 7443). I highly recommend joining the Hep Forum while you go through the process.
  • Read your health plan. Knowing what obstacles you may face will help you address them before you are denied. For example, if your plan requires documentation of abstinence from drugs and alcohol, you may be required to have a lab test to screen you for substances. I am adamantly opposed to this, but since the people who write these regulations are not asking for my opinion, then it is up to you to be sure you pass these tests. Beware that even a trace amount of marijuana may show up positive and trigger a denial.
  • Be sure you tell your medical provider about your symptoms, including the severity of them. Some common hepatitis C symptoms are fatigue, brain fog, sleep difficulties, muscle aches, joint pain, headache, depression, and gastrointestinal complaints. If you are a young woman who could still get pregnant, mention this to your doctor, especially if you are planning a pregnancy.
  • Appeal all denials. Keep appealing. Don’t ever give up.
  • Make a commitment to your health. It is very easy to feel overwhelmed by hepatitis C, especially in light of these obstacles to treatment. However, if you are going to fight for your right to treatment, then you need to be in shape. Eat right, exercise, get lots of sleep, and practice relaxation and stress reduction techniques. Avoid alcohol and drugs except when prescribed. Don’t ever give up. You are worth fighting for.
  • Complain, but complain to the right people. It may not help to complain to your healthcare provider, because they are upset too. You can complain all you want to me, but I am on your side, and other than listening, I can’t do much. Complain to your insurance company and your state’s insurance commissioner.  Tell your congressional representative what you think. Write to the newspaper. Complain loud, in print, and often.
  • Participate in a clinical trial. For more information about this option, click here.

Links to 2016 Insurance Plans/Hepatitis C Treatment Criteria:

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