Hepatitis C is a viral infection that damages the liver. Nearly 2.4 million people in the United States live with the condition, according to the
Some people don’t have symptoms in the early stage of the hepatitis C. If left untreated, though, it can cause cirrhosis (scarring) of the liver, liver cancer, and even liver failure.
The good news is that hep C is curable with antiviral medications, which can completely eliminate the virus from the body.
Despite the availability of treatment, not everyone has access to these medications. Even if you have insurance, your insurance provider might deny coverage.
Here’s a look at why your insurance might not cover hepatitis C treatment — and what you can do about it.
According to one report from 2019, more than half of people living with chronic hepatitis C are denied treatment — even with health insurance. This is due to the expensive cost of treating the condition.
Treatment is usually an 8- to 12-week course of an antiviral medication. Although treatment is short-term, it can cost up to $95,000.
For this reason, many insurance providers cover treatment only for people in advanced stages of hep C. If you have early-stage hepatitis C, your insurance provider may claim that you’re “not sick enough” for treatment.
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Yet, the longer a person goes without treatment, the greater the risk of the condition advancing and causing life threatening complications.
Paying for hepatitis C treatment out of pocket isn’t an option for many people, due to the costly nature of the medication. Here’s what you can do if you’re denied treatment.
Appeal your insurance company’s decision
Some people give up when their insurance provider denies treatment for hepatitis C. But you can fight their decision by writing an appeal letter.
Keep in mind, though, that the appeals process can be lengthy. And you might have to appeal the decision more than once.
Insurance companies vary, so contact your provider for information on its appeals process.
If possible, get your doctor involved, too. They can write a letter explaining the need for treatment.
See a liver specialist
Ask your primary doctor for a referral to a liver specialist, if you aren’t already under the care of one.
Depending on your insurance company, it might cover the cost of hepatitis C medication only when prescriptions come from a liver specialist.
Note that the copay for a liver specialist is typically higher than that of a primary care physician.
Reach out to drug companies
If your insurance provider will not cover your hep C medication, you might qualify for patient assistance programs. This is also an option if you’re uninsured or can’t afford expensive medications.
Additionally, Support Path is a program that helps eligible people pay for generic hepatitis C treatment — whether you’re insured or uninsured. If eligible for the program, you might pay as little as $5 per copay for your medication.
Consider other assistance
You can contact the American Liver Foundation for a list of financial assistance resources. Or check other websites, such as:
If you’re living with advanced hep C and you’re uninsured, see if you qualify for government health benefits. For example, if you’re over age 65 or living with a disability, you might be eligible to receive treatment through Medicare.
File a lawsuit
If your doctor says hepatitis C treatment is medically necessary yet your insurance continues to deny coverage, you can file a lawsuit against your provider as a last resort.
Outcomes vary from person to person, yet some people have won lawsuits filed against their provider, which has allowed them to receive life saving treatment for hep C.
Getting treatment for hepatitis C takes effort and patience, but it’s important not to give up. Hepatitis C is a progressive disease, so the sooner you get treatment, the lower your risk of liver complications.
Improving access to treatment can slow the spread of the virus, and possibly cure it altogether.
In the meantime, you can take steps to reduce hepatitis C transmission.
This includes getting screened for hepatitis C if you’re at risk and preventing the spread.
Don’t share needles or personal care items, practice sex with a condom or other barrier method, avoid contact with blood, and only visit reputable tattoo and piercing parlors.