I have vivid memories of my mother on the phone with health insurance providers, screaming and crying in pain for them to pay for coverage. She sustained serious injuries in a tornado we were in that created chronic and lifetime health problems.
'Deny,' 'defend,' and 'depose.'
Those were the words found on shell casings from the UnitedHealthcare CEO Brian Thompson crime scene, as reported by the Associated Press. As this could be at the top of your mind right now, I regrettably recall that this was the process my mother experienced in the claims process with her insurance company.
The murder of Brian Thompson was a tragedy. Nobody should be murdered. It is an awful tragedy that sickens me. Company executives should not fear for their lives, but neither should regular people like my mother begging for the care she paid to receive.
According to the same AP article, customers appeal less than 1% of medical care and drug payments denials. Perhaps this is because some insurers deny services and payments using the deny, defend, depose process, which is routine in their business model.
A KFF analysis shows that insurers, on average, deny almost 1 in 5 claims and that some reject more than 1 in 3 each year. Even as lawmakers work to prevent this, many insurers continue to break the law by refusing to pay for care, which has been the case for years.
The inexcusable murder of Brian Thompson has brought to the surface the sad realities of the difficulties folks face when filing health insurance claims.
Insurance isn't getting any cheaper, either. In fact, insurers project another double-digit increase in global healthcare costs in 2025.
Free Tool for Next Steps Following Denied Coverage
As part of ProPublica's "Uncovered" series on health insurance denials, they created the Claim File Helper tool. This tool lets you customize a letter requesting the notes and documents your insurer used when deciding to deny you coverage.
Click here or click the image below to access the free tool.
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