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Hepatitis C: when insurers say no, reviewers often say yes

In 928 published external-review decisions involving hepatitis c, independent physician reviewers overturned the insurer’s denial 82.9% of the time.

Published decisions
928
2001–2026
Overturned
82.9%
769 denials reversed

Most-fought treatments for hepatitis c

What insurers denied — and how those fights ended.
TreatmentDecisionsOverturned
Harvoni406
87.4%
Epclusa105
88.6%
Zepatier87
88.5%
Mavyret68
95.6%
Sosvaldi63
74.6%
Sovaldi39
59%
Vekira Pak13
76.9%
How to use this in your appeal

These outcomes come from California’s external review program — an independent physician panel whose decision binds the insurer. Every state has an equivalent, and internal appeals succeed even more often. If your care for hepatitis c was denied, the published record says the denial is worth fighting.

SOURCE: CALIFORNIA DMHC INDEPENDENT MEDICAL REVIEW OUTCOMES (CHHS OPEN DATA) · DERIVED AGGREGATE STATISTICS ONLY · METHODOLOGY

Not legal or medical advice. Coverage Rights is a self-help tool that helps you prepare your own appeal. For advice about your specific situation, talk to a licensed attorney or your doctor.

Fighting a denial for hepatitis c? 82.9% won.

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