Why do health insurance companies deny medical treatments?

Health insurance companies often deny treatments based on their determination that they are 'not medically indicated,' or to manage costs, as their business model can incentivize limiting customer usage.

How often do insurance companies deny claims like those faced by Dan Hurley?

In 2024, insurers denied 19% of in-network claims. For United Healthcare, denials were as high as one-third of federal claims in prior years.

Can doctors like Elisabeth Potter be sued by insurance companies?

Yes, doctors can face legal threats, such as defamation suits from insurance companies, for speaking out against their practices, as seen in Dr. Potter's case with United Healthcare.

Home / Health / Health Insurance: A Fight for Life

Health Insurance: A Fight for Life

11 Jan

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Summary

Insurers deny 19% of in-network claims, impacting millions.
A former insurance insider reveals the incentive to deny care.
Patients and doctors face arduous appeals against denials.

Millions of Americans are entangled in a harrowing fight for medical care due to health insurance denials. Traci Hurley recounts her husband Dan's battle with chondrosarcoma, a rare bone cancer, exacerbated by numerous insurance claim rejections for tests and treatments, including chemotherapy and radiation. Despite both being physicians, they faced significant hurdles, highlighting the plight of those without medical expertise navigating these complex systems.

Ron Howrigon, a former health insurance consultant, explained the inherent conflict in the industry's business model: the more customers use services, the less profitable the company becomes. This creates a financial incentive to make accessing care difficult. A CBS News analysis in 2024 revealed insurers denied 19% of in-network claims, a rate that could be higher for some major providers like United Healthcare.