HCV DAA Treatment Appeal Letters
Algolia Search
Schedule Telemedicine Consult with Dr. Gish Powered byTelemed2U
Powered byTelemed2U

HCV DAA Treatment Appeal Letters

The template letters below are offered to help with challenging health plan coverage denials of Direct- Acting Antivirals Agents. The letters may be downloaded and modified for submission to health insurers.

Acknowledgements: Thank you to Kris Kowdley, MD with Swedish Medical Center for contributing the draft template letters.

Denial Appeal - GT1 Naive 12 Wk Treatment With ViekiraPak and Riba for Cirrhotic INF Contraindicated Patient.docx

Denial Appeal - GT1 8-Week Sovaldi for INF Contraindicated Patient.docx

Denial Appeal - GT1 Harvoni Re-Treate Post Sofosbuvir and Ribavirin Relapse.docx

Denial Appeal - GT2 Re-Treat with Sovaldi and Riba Post INF-Riba Fail.docx

Denial Appeal - GT3 Naive 12 Wk Treatment With Daklinza-Sovaldi.docx

Denial Appeal - Generic GT3 Naive 12 wks F0-2 DacSof.docx

Denial Appeal - GT1 12-24-Week Harvoni and Riba for decompensated INF Contraindicated Patient.docx