Centene Health Insurance Companies Refuse to Pay for Hepatitis C Treatment Class Action

How would you feel if you developed an often-fatal liver disease? Now imagine that a cure became available—but your insurer refused to pay for it until the damage to your liver was irreparable? That’s the case with new hepatitis C drugs and Centene Corporation, says the complaint for this class action.

The class for this action is

• All persons who were or are insured by Centene’s subsidiaries under a Health Insurance Marketplace plan or other individual or commercial plan,
• Who have hepatitis C and stage F0, F1, or F2 fibrosis,
• Who have received a prescription from their doctor for a cure, but
• Who have been denied coverage for the treatment by Centene’s subsidiaries based on fibrosis restrictions.

Those who have Medicare or Medicaid plans through Centene’s subsidiaries are not included in the class.

Until 2014, there was no cure for hepatitis C, a disease which is often fatal. According to the complaint, it kills more people per year than any other infectious disease. The only available treatments lasted twenty-four to forty-eight weeks, the complaint says, using daily pills and weekly injections of Interferon, with debilitating side effects and an abysmal cure rate of only 16%.

In October 2014, however, new drugs came on the market that treated patients in eight to twelve weeks, with a cure rate of 94% or better, eliminating hepatitis C from the body forever. There is only problem, the complaint says: Certain insurers, like Centene Corporation and its health insurance companies, are refusing to pay for them.

When the drugs came on the market, the complaint says, they were expensive (about $100,000) but substantially less expensive than a liver transplant ($500,000) or even Interferon treatment. Unfortunately, the complaint says, insurers like Centene make patients wait until they have developed irreparable liver damage. That is, they have limited treatment to those who already have severe and irreparable liver fibrosis or cirrhosis, a practice the complaint calls “reckless and dangerous” because it increases the chance that the patient will get liver cancer, which has one of the highest mortality rates among cancers.

Centene’s insurance companies promise to pay for medically necessary treatment, the complaint says, but refuse to pay for this one. The complaint quotes medical papers and experts that recommend treating all patients and that condemn the idea of making patients wait. Health insurers such as Florida Blue, United Healthcare, Anthem, and state Medicaid agencies have already been sued and forced to abandon their fibrosis restrictions. In addition, the New York State Attorney General call fibrosis restrictions “misleading” and “deceptive” and told insurers to stop using them. 

However, the complaint claims, Centene and its subsidiaries are still enforcing their fibrosis restrictions. The complaint claims tortious interference and unjust enrichment, among other things. 

Article Type: Lawsuit
Topic: Consumer
Tags: Denial of Benefits, Health Insurance