Tips for Navigating Harvoni Insurance Denials

If you or someone you love has Hepatitis C, facing a potential denial of coverage for Harvoni treatment from your insurance provider is no simple feat. (Read more about Harvoni and Harvoni-related insurance denials.)

But there are ways you can improve your chances of an approval and actions you can take to appeal a denial once received.

Review your insurance policy in detail.

Being familiar with your policy allows you to anticipate any obstacles you might face in advance of a denial.  Some insurers require proof that you have been drug and alcohol free for a duration of time prior to approving the treatment.  Others might require information about alternative treatments you received and the outcomes.

Enlist the support of your medical provider.

Harvoni denials are nearly as frustrating for doctors, who want nothing more than to cure those who are suffering, as they are for patients. Describe the full extent of your symptoms and ailments to your doctor at each visit and work together to present the best case to demonstrate your “medical necessity” for treatment. If your doctor is either unwilling or without the resources to appeal unlawful denials on your behalf, seek out a doctor or other professional who might be able to help.

Make use of Gilead’s Support Path.

This support website and prescription assistance can prove useful to certain individuals faced with insurance denials or other challenges to obtaining Harvoni.

Consider your legal options.

If you have experienced progressively worsening symptoms and failing health due to insurance denials of Harvoni, you may want to consider your legal options.  Depending on the circumstances, you may have a claim against your insurer for breach of contract, intentional infliction of emotion distress, insurance bad faith, breach of fiduciary duty, or other common law torts.

Lawyers at Vinas and Deluca would be happy to answer any questions you might have about your personal experience with Harvoni-related insurance denials. Feel free to contact us with any questions you may have or if you wish to have a free consultation with one of our attorneys.

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