Class action lawsuit filed against Blue Cross
The latest drugs available for Hepatitis C have some very high cure rates. Unfortunately, the cost of these drugs is very high, too. It’s also one that some healthcare insurers are not willing to pay.
In four states, a recent study found that about 16 percent of patients who submitted a prescription for Solvaldi or Harvoni were denied. A Yale University study found that one-quarter of patients who are prescribed the drugs are denied.
What happens when a patient is denied a life-saving drug? They can appeal their claims, but if their appeals are not approved, they have to become sicker.
Blue Cross has been hit with a class action lawsuit by thousands of its insured who have Hepatitis C. Blue Cross is apparently only allowing the sickest patients to have access to the drugs.
The main plaintiff in the case tried many times to get Blue Cross to authorize Harvoni; however, the claims were denied because the insurance company decided it was “not medically necessary.” After paying for the medication herself for 8-weeks of treatment, physicians can no longer detect the Hepatitis C virus in her blood.
There is another class action lawsuit in Florida against Blue Cross and Blue Shield of Florida for the same reason — denial of treatment. The main plaintiff in that case was told that she wasn’t eligible for treatment because her “liver had not sufficiently deteriorated.”
If you feel you have been wrongfully denied a claim, you should consider an appeal. An attorney can provide additional information on how to proceed. You should not be wrongfully denied insurance benefits simply because of the cost of the medication.
Source: ajmc.com, “Blue Cross Sued Over Denying Patients Hepatitis C Treatment,” Laura Joszt, Nov. 30, 2015