Liver disease coverage

Liver disease coverage is a health insurance benefit that pays for medically necessary treatments, diagnostics, and hospitalizations related to liver conditions such as hepatitis C, cirrhosis, and fatty liver disease. Most major medical plans cover FDA-approved medications for chronic liver diseases like Harvoni (for hepatitis C), subject to formulary restrictions and prior authorization.

Insurers typically require documented diagnosis codes (ICD-10 K70-K77) before approving claims for liver-related care. Policies often exclude experimental therapies or unproven supplements marketed for liver support, as seen in exclusions from UnitedHealthcare and Aetna policy documents.

Pre-existing condition clauses may delay coverage of non-emergency liver treatments by up to 12 months in some short-term health plans, as shared by YourInsurance.info. Out-of-pocket costs for covered liver biopsies average $1,000–$2,500 depending on deductible levels in PPOs versus HMOs.

Marketplace plans must include preventive screenings for hepatitis B and C per ACA Section 2713 at no cost-sharing if risk factors exist. Medicare Part D covers antiviral drugs but requires enrollees to meet annual deductibles ($545 in 2024) before coinsurance applies.

Supplemental critical illness policies sometimes pay lump sums ($5,000–$50,000) upon confirmed diagnosis of end-stage liver failure according to MetLife’s underwriting guidelines.