Hepatitis C Patient Denied Medicine to Treat Chronic Condition

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Hepatitis C Patient Denied Medicine to Treat Chronic Condition

When Susan first reached out to us through the Share Your Story portal we were blown away by her devastating story. It confirmed the reason we launched “My Patient Rights” as a resource for California’s health care consumers. The best part of this story is that Susan’s issues were resolved – all through filing a complaint.

Several months ago, California resident Susan V., was denied Harvoni by Anthem Blue Cross, even though Susan was diagnosed with Hepatitis C. After being denied access to this important medicine for her chronic condition, Susan told us she felt like Anthem was telling her she just wasn’t sick enough to warrant the treatment.

Susan filed a grievance to contest the denial, sending Anthem all of the necessary documentation to “prove” she had Hepatitis C, as well as all of the tests and procedures she had received in the past.

Even though Susan was supposed to hear back from Anthem in 30 days, as required by California law, 30 days came and went and she heard nothing from Anthem 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 could all be managed if Susan had access to the medicine she needed to address the root of the problem: Hepatitis C.

Then Susan learned about our new website and reached out to the “My Patient Rights” team with her story. She also filed a complaint with the Department of Managed Health Care (DMHC).

Soon after, Susan was contacted by the Independent Medical Review Board at the DMHC and Anthem’s decision to deny Harvoni was overturned.

While we are thrilled for Susan, this battle was completely unnecessary. California’s health care consumers should not have to fight for the tests, procedures or medicines they NEED. Her story is a great example of the reason why “My Patient Rights” was launched and why we are dedicated to helping patients know where to go to file a complaint and get the health care they need and deserve.

 To read other stories from California patients please click here.

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 “My Patient Rights” team, please click here.

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