Had trouble with a health-insurance claim? An appeal? National, nonprofit newsroom ProPublica wants you to help its reporting

By Al Cross Published November 12, 2022 FEATURED, HEALTH BUSINESS, HEALTH POLICY, YOUR HEALTH

ProPublica, the national, nonprofit, investigative newsroom, wants Americans to help it report why health insurance claims are denied, what the consequences are for patients, and how the appeal process works. It says it has heard from hundreds of people about the obstacles they have faced when denied health care.

“Take Alyssa Miller, a hospital-based nurse,” ProPublica reports. “When she was 16, she was diagnosed with cancer and had to undergo radiation treatment. Given her now-increased cancer risk, her oncologist said she’d have to get a mammogram by 25. But when she went to get the procedure, Miller’s insurer denied her claim because, per its policy, it only covers mammograms when patients are 40 or older. She fought back with an appeal backed by a note from her doctor. That was denied, too.”

Miller told ProPublica, “I was just really frustrated and confused by the whole appeals process. I feel like I’m supposed to know how this works being a health care provider. I almost gave up.”

Miller was able to get her mammogram covered by asking her employer’s human-resources office to get involved, ProPublica reports, “but she is among just a small percentage of people who appeal these denials. . . . Even insurance company employees, doctors and nurses have to battle insurers for coverage for themselves and their family members.”

ProPublica said it has heard from “more than 100 people who work in health care or insurance and have had difficulty getting care covered, including:

A doctor whose son has a speech disorder but had to stop speech therapy because insurance would not cover it.
A nurse practitioner with long COVID whose treatments are being denied by insurance.
An ophthalmologist whose uncle had a detached retina, which can cause blindness without treatment. The insurer denied the surgery because it concluded the procedure was not emergent.

Now we are hoping to hear from more people who can help us understand what is happening on the inside as these decisions are made. If you or someone you know works in health insurance, please fill out this form.” If not, use the link in the first paragraph of this story.