Medical insurance companies are denying access to Harvoni (ledipasvir/sofosbuvir) to treat the Hepatitis C of their patients. Companies such as Blue Cross, Blue Shield, United Healthcare and others health insurance companies are allegedly denying first, and then seeing how many of their patients continue to try to get the medical treatment.
What Is a Denial of Harvoni?
After your doctor has prescribed Harvoni, your health insurance company sends you a letter that states you are not covered to receive this drug. The letter that you receive when you are denied Harvoni will generally state something along the lines of, “It has been determined that Harvoni is not medically necessary,” and that insurance is denying the payment for the drug.
How Can My Insurance Deny My Medical Treatment?
When you have medical insurance, it is a contract between you (the patient) and the insurance company. The contract includes you paying your monthly premiums for your health insurance, and in turn, the health insurance company pays for certain medical treatments when the treatment is “medically necessary.” There are also certain conditions stated in your contract with your medical insurance company that are not covered. For example, medical insurance generally will not cover procedures that are not needed, such as Lasik or cosmetic Botox. However, medical insurance should cover necessities such as breathing medication, disease treatment, cancer therapy, etc.
An insurance company will state to you what treatment they believe is medically necessary. When the treatment is not medically necessary, they will not pay for the treatment, and therefore the doctor and/or hospital will not do the treatment, because they will not be paid. In this situation, the medical insurance company does control the types of medical treatment you can get, because if they will not pay for it, the hospital will not do the treatment, unless you agree to pay the exorbitant cost out-of-pocket.
Who is denying me?
A denial of medical treatment occurs when a doctor states that you should get medical treatment and sends for approval from the insurance company, and the insurance company states that you do not need the treatment.
Therefore it is not the doctor that is denying your medical treatment. Nor is it the hospital that is denying your medical treatment. It is your own health insurance company (Blue Cross/Blue Shield, United Healthcare, Kaiser) that is denying your medical treatment.
Why have I been denied access to Harvoni?
Your health insurance company denied your claim because the cost of the drug. The cost is expensive, and therefore your health insurance company does not want to pay for the medical treatment. Every denial that your health insurance company issues saves the company money.
We are currently investigating the ongoing medical denials of Harvoni, because we believe aspects of these denials are against the law. We believe patients who are recommended Harvoni should receive Harvoni. It is that simple. When a patient pays for medical insurance and then is denied the proper medical treatment, it is time for a law firm to get involved.
What are my options if I have been denied?
- You can appeal your denial. This is the fastest and has the best chance of having the decision overturned.
- You can become part of our investigation.
- You can file a lawsuit, either individual or as part of a class action.
Can I appeal the denial?
You can appeal the denial. You have a certain amount of time in which your medical doctor can appeal the decision within your insurance company. Sometimes your medical insurance company will change their mind.
How long do I have to appeal?
You have 180 days from the date of denial to appeal your case to your insurance company. While we have often seen letters that state a different number than 180 days, these letters are relatively rare.
What is the process to file an appeal?
You file the necessary paperwork with your medical insurance company. The forms are different company to company, but by law, the appeal paperwork will include you name, claim number and insurance number. We recommend that you also include a request that if your appeal is denied, please state the reason for the denial in writing.