| > The examples I heard of are never straightforward like "person has a broken hip, insurance refuses to pay for a hip replacement". There's always some complication like "the doctor thinks they need some special procedure/drug that costs extra". There are a couple examples in the legal complaint (https://cdn.arstechnica.net/wp-content/uploads/2023/11/class...) where the insurance company denied extremely typical things like physical therapy and skilled nursing facilities (the most common form of post-acute care). Nothing special there. Here's another one for you: Deirdre O'Reilly's college-age son, suffering a life-threatening anaphylactic allergic reaction, was saved by epinephrine shots and steroids administered intravenously in a hospital emergency room. His mother, utterly relieved by that news, was less pleased to be informed by the family's insurer that the treatment was "not medically necessary." (https://kffhealthnews.org/health-industry/denials-of-health-...) Now, I don't have all the details of this case, but neither epinephrine shots or steroids are a special procedure/drug. That would be considered the standard treatment for life-threatening allergic reactions depending on the circumstances and how long ago this occurred. I can't think of any reason why they'd ever deny epinephrine, and although steroids have fallen out of favor in recent years as standard treatment in every case, they are still called for in common situations like when epinephrine alone isn't doing the job, or when the reaction has triggered an asthma attack. The article that came from links to https://www.npr.org/series/651784144/bill-of-the-month which is filled with all kinds of examples including one where the insurer eventually relented after phone calls, appeals were filed, a complaint was made to state agency, and letters were sent to elected officials (
https://www.npr.org/sections/health-shots/2024/01/25/1226552...) Social media is full of outrageous examples (https://www.buzzfeed.com/morgansloss1/stories-of-healthcare-...) but you're probably going to get the best examples from news segments like that Bill Of The Month series. Evaluating these can be challenging. Even though many people are sharing their stories of how they've been screwed over online (and publicly exposing their private medical matters in the process), there's often a lack of hard details. Both government regulations intended to protect patients and insurance industry policy intended to protect the corporations can make independent verification of these complaints difficult. The best source for examples will be lawsuits against insurance companies which can surface instances collected through the discovery process and used as evidence at trial, but that can take many years and may never come to light if those lawsuits get settled first with the victims and their surviving loved ones paid off and silenced. |