State of denial: How insurance companies impact health care today

Traci Hurley said watching her husband battle cancer at the end of 2021 was painful. “It’s heartbreaking and it’s horrible,” she said. “I live in fear every day.”

The battle was made worse, she said, because many of the skirmishes were with their insurance company. “No family should have to fight for their life while also fighting to get the treatment their doctor recommends,” she said.

Millions of Americans say they are struggling to access care: either unable to pay sky-high deductibles or, like Dan Hurley, being denied coverage for tests and treatments by health insurance companies. The Hurleys were not only doctors; Dan is an ENT surgeon who also specializes in navigating insurance red tape for his patients.

“However, we still have a lot of problems,” Tracy said. “If we, as two doctors, have to work so hard to get medical approval, what about those people who have no medical knowledge? What is happening to them every day?”

Dan was an avid hiker until nagging back pain turned out to be cancer. He was diagnosed with chondrosarcoma, an extremely rare bone tumor. To save his life, both the tumor and Dan’s hip had to be removed. Insurance only covers part of the cost.

“He was denied a lot of treatments. We had PET scans, we had CT scans and they were all denied. We had chemotherapy, we had radiation, we had certain medications that required prior authorization and they were all denied,” Tracy said.

Tracey said the basis for the insurance company’s denial was that they had “no medical indication.”

“Make their lives as difficult as possible”

Ron Howrigon, now a consultant, has worked for health insurance companies for two decades. “Health insurance companies know that 5% of their members bear 50% of the costs,” he said. “So I have a huge financial incentive to make their lives as difficult as possible.”

Howrigon says this business model is different from other industries: “The more your customers use your product, the less money you make. Your incentive is to prevent them from using your product.”

How often do insurance companies deny paying medical bills? It’s hard to tell; health insurance companies only need to report denial data for plans purchased through healthcare.gov.

A CBS News analysis of about 1.3 billion federal health insurance claims over three years shows that through 2024, insurers will deny 19% of in-network claims, or about one in five.

But for UnitedHealthcare, the largest insurer, that number is down sharply from the previous two years, when it denied as many as a third of federal claims.

While UnitedHealthcare did not provide data to support it, it said that across all of its plans, their initial denial rate was 10%. They also note that when employers self-insure, the plan they choose for their employees drives the coverage decision.

“Approximately 165 million Americans are enrolled in employer-sponsored health care plans, 65% of whom are enrolled in so-called self-insured plans,” United said in a statement. “The health insurance company they choose provides administrative services, such as handling members’ calls and paying claims. But as the term ‘self-insured’ implies, it is the employer’s funds that pay the claims…

“Self-insured employers can design their health plans and determine what is and is not covered for employees,” United continued. “It’s important to remember that your health insurance company may not have designed it this way. Your employer did.”

“Insurance out of control”

“Insurance companies are honestly making it harder to stay healthy in America,” said Dr. Elisabeth Potter, a surgeon who sees up to 60 breast cancer patients a week at RedBud Surgery Center in Austin, Texas.

Denying coverage can actually increase costs, she said: “I have two employees who spend almost all day looking for coverage. It seems like everywhere we go, there’s a problem, whether it’s the insurance company saying, ‘You know, we’re not going to cover your surgery at that surgery center,’ or ‘We’re not going to cover the cost of that drug, and we want you to get a different drug.'”

Case in point: One early morning last fall, Jeannie Lee, a 40-year-old mother with breast cancer, was preparing to undergo lymphovenous bypass surgery, a procedure that would have been performed during a double mastectomy two weeks earlier, but which both her and her husband’s insurance companies refused to cover.

Porter said Lee is at high risk for lymphedema and “just using your arm can become very difficult. It can be painful. It can swell. It can also become deformed.”

Ms. Li said: “I am 40 years old this year and have three children. This surgery is very necessary.”

Once Lee was able to get financial assistance through a new nonprofit organization established by Dr. Porter, she returned to surgery. “This patient was having an additional procedure that required a separate general anesthesia because her insurance company would not cover the procedure,” Porter said. “We could easily do both at the same time [as her mastectomy ]”.

When she wasn’t having surgery, Porter often called her insurance company’s medical directors to defend her treatment decisions, who she said often knew little about her field of medicine. “Sometimes I go to an ophthalmologist, an ophthalmologist. It’s completely ridiculous,” she said.

She sometimes posts her thoughts on these conversations online.

Porter: “So, we’re talking about lymphedema in the arm. So, this is not familiar territory for you, right?”

But she said a video she posted in early January 2025 ultimately put her entire medical practice at risk. Porter said she received a call from UnitedHealthcare while she was in the operating room. She said the “urgent” call was to inquire why her patient needed to stay overnight in the hospital.

“This had never happened before. I didn’t know what was going on, but they said it was urgent and I needed to call, so I called,” she said. “I’m doing surgery. I’m doing the right thing for the patient. I’m keeping her overnight. I’m walking out of the hospital and I’m just filming myself in an unfiltered moment.”

Porter: “Everything is out of control. The insurance is out of control.”

Shortly after she posted the video, she received a letter from her insurance company threatening to sue her for defamation. “I take great care of my patients. They were just trying to scare me into keeping quiet,” Porter told us.

I asked: “Aren’t you afraid?”

“I was Scared,” she replied.

UnitedHealthcare has not yet taken Dr. Porter to court. They declined to be interviewed on camera, but a company spokesman said the call was due to a faulty order and that a doctor would never be asked to leave an operating room because of a call about an insurance issue.

‘What a punch’

Miranda Yaver, an assistant professor at the University of Pittsburgh, said insurance companies know that only a small percentage of people will actually appeal a claim denial.

“We are all susceptible to rejection,” she said. “Not everyone has it easy when it comes to calling out and overcoming these barriers.”

Aphek calls it “inconvenience rationing.”

“A lot of people don’t know they can even appeal,” Yaffe said.

I asked, “Are you saying that it’s not denial that ultimately prevents people from accessing care, but that people give up?”

“While people win about half of the time, less than one percent of in-network claim denials result in an appeal,” Yaffe said.

Clearly, appeals are indeed worthwhile, but some patients, like Dr. Dan Hurley, who is battling aggressive cancer, are running out of time. His wife, Traci, said he spent much of his final months on the phone with insurance company workers: “He would contact them line by line, and they’d say, ‘Well, yeah, we need a supervisor to step in. We’ll call you back.'” And then they wouldn’t. “

Dan’s goal, she said, is to hold insurance companies to similar standards as doctors, holding them liable for malpractice when they deny life-saving care. “The act of signing a denial is the practice of medicine,” Tracy said. “Similarly, if a patient comes to me and I make a treatment decision and it goes off the rails, I’m held accountable. That’s how it works.”

Dan Hurley passed away on August 3, 2023. A week later, his wife received a letter from her insurance company asking her to pay $80,000 for a round of chemotherapy that had been preauthorized, but was suddenly and retroactively denied. “It was a big blow to get it that day,” she said. “It’s unbelievable, right? Almost laughable.”

Dan Hurley’s battle became his widow’s battle. “Part of me would be like, ‘Oh, he’d be proud of me,’ but another part of me would be like, ‘Come on, chop, chop, you got this, go ahead, pick it up, don’t be sad, you know, move on.’ Because that’s the kind of person he is.”

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Story by Sari Aviv. Editor: Jason Schmidt.