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Home / Health / Health Insurance: A Fight for Life

Health Insurance: A Fight for Life

11 Jan

•

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.
Health Insurance: A Fight for Life

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.

Doctors like Elisabeth Potter in Austin, Texas, also face immense challenges, with insurance denials adding to patient costs and requiring extensive administrative work. Potter herself faced defamation threats from United Healthcare after posting about an urgent call received while operating. Patients like Jeannie Lee, battling breast cancer, require financial aid due to denied procedures. The current system, often described as 'rationing by inconvenience,' leaves many vulnerable, with fewer than one percent of denials appealed, even when appeals are often won. Dan Hurley passed away in August 2023, leaving his widow to continue the fight for accountability.

Disclaimer: This story has been auto-aggregated and auto-summarised by a computer program. This story has not been edited or created by the Feedzop team.
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.
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.
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.

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