Denied access to treatment? Help is here for health care users.

My Patient Rights > Denied access to treatment? Help is here for health care users.

Denied access to treatment? Help is here for health care users.

Earlier this year, Susan V.’s health plan denied her request for a prescription for Harvoni, even though  for her, the medicine was the most effective Hepatitis C treatment. To Susan, the denial felt like her health plan telling her she “just wasn’t sick enough” to warrant treatment.

Every day, patients navigate obstacles obtaining the care they need, including scheduling appointments with specialists, accessing life-saving medicines or attaining tests and examinations.

That’s why the California Chronic Care Coalition launched, an online resource to help patients identify when, why and how to file a complaint with their health plan and/or the California Department of Managed Health Care (DMHC) to demand the care they need and deserve.

Susan shared her story on to figure out how to move forward. Eventually, Susan’s issues were resolved – all through filing a complaint.

After the denial, Susan filed a grievance to contest her health plan’s decision, sending through all necessary documentation to “prove” she had Hepatitis C, including the results from tests and procedures she received in the past. Even though Susan was supposed to hear from her health plan in 30 days, as required by California law, 30 days came and went and she heard nothing about her appeal.

Meanwhile, the associated conditions of Oral Lichen Palnus – constant mouth sores that come along with untreated Hepatitis C – Portal Hypertension, Esophageal Varices and constant fatigue continued to wreak havoc on her body. These conditions are manageable with the medicine she needed to manage her Hepatitis C. Instead, she suffered.

Then Susan learned about our , she shared her story and filed a complaint with the DMHC. Soon after, the DMHC’s Independent Medical Review Board overturned her health plan’s decision to deny Harvoni.

California’s health care consumers should not have to fight for the tests, procedures or medicines they need. Susan’s story is an example of why launched and why the California Chronic Care Coalition is dedicated to helping patients know where to go to file a complaint and fight for the health care they need and deserve.

To find out where you should file a complaint to get the health care you need please click here

To share your story with the, please click here.

 To read other stories from California patients click here.


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State and federal law protects your rights. When you sign up for a health plan and/or if you have problems accessing care through your health plan, it is important to know your rights.