After the killing of the United Healthcare CEO, many people have shared stories of being denied coverage by medical insurance companies, highlighting an issue that working-class Americans are struggling with every day.
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After reading stories from the patients’ perspectives, we decided to ask medical professionals to share the times they have witnessed insurance companies fail their patients. One line from the responses we recieved stood out: “Until insurance companies are not-for-profit private organizations, the bottom line will always trump patient care.”
Here’s what 19 medical professionals had to say:
1.There’s the surgeon whose diabetic patient’s insurance refused to pay for a prosthesis or wheelchair after his leg was amputated:
“I’ve been an orthopedic surgeon for 32 years. I had a patient with diabetes and peripheral vascular disease who ended up needing an amputation of one of his legs to save his life. The insurance paid for the amputation but would not pay for a prosthesis or wheelchair! Really?!”—Anonymous
2.There’s the nurse whose patient suffered a heart attack and died waiting for medical insurance approval:
“As a nurse, I’ve seen plenty of situations where an easier test or procedure was denied, leading to the patient having more serious health issues that could have been prevented. One that I will never forget is a patient who’s insurance denied a cardiac catheterization. The hospital staff spent half the day trying to get it approved; the doctor even talked to another doctor at the insurance company. The patient had a heart attack and died before they could get the approval. It was heartbreaking.”—Anonymous
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3.There’s the patient whose insurance company left him bedridden for five days after not sending a home health nurse:
“I was a nurse discharge planner in a hospital and had an elderly diabetic patient who had a large, open wound on one of his legs. After he underwent surgery, he improved and was able to be discharged home, but he needed a nurse to come out daily to do his dressing changes as well as a physical therapist to help him with his mobility. He lived alone and had no one to help him. Normally, I would make a referral to a home health agency, but this patient’s insurance company required me to call them. They refused to let me make the referral and said they would do it and inform the patient. I wasn’t happy with this, but my hands were tied. I heard later the patient was not seen for five days and ended up being admitted to another hospital. So, they had to pay for two admissions, and the patient suffered. I wish the paper pushers would let the medical professionals do their job; we know what we’re doing.”—Anonymous
4.There’s the hospital worker who is constantly writing medical insurance appeal letters:
“I work in the hospital revenue cycle, and part of my job is to write appeal letters to the insurance companies because they denied a patient who had a diagnosis that was actually treated and monitored. Therefore, the hospital owes a ‘refund’ to the insurance company.”—Anonymous
5.There’s the doctor’s office employee who witnessed a medical insurance company deny newborn babies procedures to allow them to eat properly:
“I work in a doctor’s office. Periodically, we see newborn babies that are tongue-tied and cannot latch to feed. The baby cannot eat. The insurance company denied the simple procedure to correct the condition, saying it was ‘pre-existing’ because the baby was born that way.”—Anonymous
6.There’s the doctor whose severely diabetic patient died from their insurance not covering insulin:
“I had a severe diabetic patient who worked but had bad insurance. They would not cover his insulin. His diabetes was very poorly controlled for years. I used to accept donations of unopened sterile insulin, and when I got a donation, I would drive it to his workplace and drop it off to him with instructions. It wasn’t enough and his glucose was usually very high. He died at the age of 62 of severe complications of poorly controlled diabetes.”—Anonymous
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7.There’s the ER doctor who witnessed a woman receive life-saving heart surgery that her insurance refused to cover:
“We had a 27-year-old woman come to the ER having a heart attack. The on-call cardiologist performed a life-saving surgery and placed a stent. Her insurance denied covering the surgery over and over because of a recently published study stating a medication had been shown to be as effective for long-term care and deemed the surgery ‘medically unnecessary.’ The medication the insurance decided was a better solution is not recommended for women of childbearing years. The insurance company then said she was no longer considered to be in child-bearing years. They left her owing over $60k in medical bills. Until insurance companies are not-for-profit private organizations, the bottom line will always trump patient care.”—Anonymous
8.There’s the resident who argued with a medical insurance agent for their patient’s breast cancer treatment:
“So many stories, but this occurred during residency and made me realize what I was in for. A patient had biopsy-proven breast cancer. I had to get pre-authorization for a mastectomy and lymph node dissection. After a long argument with a guy who sounded ancient, he said, ‘I’ll approve the mastectomy but not the lymph node dissection since it’s just for staging and not a treatment!’ Of course, the treatment depends on the staging.”
9.There’s the medical insurance company that only agreed to approve the claim if the patient needed emergency surgery but refused to approve the scan to evaluate the aneurysm:
“I’m a nurse. I used to work at a primary care office. I was trying to get a surveillance CT scan approved for a patient with a known AAA (abdominal aortic aneurysm) to see if the aneurysm was stable or getting bigger. The insurance company told me they could only approve it if we thought it was dissecting. That would mean the aorta was splitting open, which is a surgical emergency. I literally said to the person on the phone, ‘If we thought it was dissecting, he’d be in the hospital dying, and we wouldn’t be having this conversation.’ Pretty sure if you’re having a dissecting aneurysm, you don’t stop and call the insurance first, but what do I know? I’m just a nurse.”
10.There’s the British medical student who witnessed a homeless patient be escorted from the hospital because he didn’t have insurance:
“I’m British. As a student I did a secondment in New York City. There was a patient who presented to the emergency department with rectal bleeding. He was 23 and homeless. Without insurance, funds, or anyone to cover his treatment, he was escorted by security from the hospital in December. I was furious! We have a tax-payer-funded, free point service still in the UK. He would have survived here but was left to die in the States.”—Anonymous
11.There’s the medical insurance company that tried to deny a CAT scan to a man with kidney cancer:
“A patient came to see me Monday afternoon late with left-sided abdominal pain. It was too late in the afternoon to get an emergency CAT scan because everything was closed, so I gave him medicine for a possible infection called diverticulitis and told him we would get a CAT scan in the morning; we got approval for a CAT scan. His insurance company said no. I called him and told him he had to go to the hospital to get a scan. He said I will call you right back, and he called and yelled at an insurance company, and they gave in. The following day, we ordered a CAT scan of his abdomen; he had the largest kidney cancer I’ve ever seen.”—Anonymous
12.There’s the worker’s compensation denial that caused a patient to develop a disc hernia in his neck that needed surgery:
“I was an NP for workers compensation program. I had a large, powerful, beautiful Black man with mental slowness who was crushed between a loading dock and a truck. He had severe nerve damage to his arms and pain in the neck area. I ordered an MRI of the neck and upper spine to evaluate disc bulges or herniations, which could permanently paralyze the patient from the neck down. The worker comp adjuster denied MRI until he had done weeks of physical therapy. I was concerned the PT could paralyze him as we did not know how bad his spine was. I had to essentially waste PT visits by consulting with the MD whom I worked for and the PT staff to only do gentle, safe therapy. He ended up with a big disc hernia in his neck that needed surgical repair or risk paralysis from the neck down. Worker comp denials are profound and so common.”
13.There’s the physical therapist assistant whose patient’s insurance denied her PT even though she couldn’t raise her arm above her head:
“Physical Therapist Assistant. Just last week, we had insurance deny a patient who had shoulder manipulation under anesthesia to treat a frozen shoulder. These patients need intense PT afterward. After 15 visits, we submitted for approval for more visits because she still lacked the strength to raise her arm over her head. Her job is physical, and she did not have the range of motion, strength, or endurance to adequately do her work. Insurance denied because it wasn’t ‘medically necessary’ when she is literally unable to work.”
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14.There’s the medical insurance company that insisted a patient who recieved blood transfusions for postpartum hemorrhage go home that same day:
“Years ago, a patient had a baby, then got treated and had blood transfusions for postpartum hemorrhage. The insurance person still insisted that the patient go home that day by midnight cause they weren’t going to pay another day. The doctor even called the insurance company. No change. We all told the patient and family that it was safer to stay at the hospital another day, and the hospital could work something out. They still left by midnight.”
15.There’s the medical insurance company that tried to deny a patient’s claim for the medication their doctor recommended:
“I worked on the general medical floor in my hospital at the time. My former mother-in-law had small cell lung cancer and was admitted three separate times for low sodium levels, a common complication of small cell lung cancer. On her first admission, they had a kidney doctor come to see her, and he wanted to put her on a medication that would fix the low sodium for good. Her insurance company denied the claim for this medication, claiming it was too expensive. Her subsequent hospital admissions cost way more than that medication. The doctors and her husband had to fight tooth and nail to get the insurance company to finally approve the medication. Otherwise, she would have continued to be hospitalized for low sodium for the remainder of her last year of life.”
16.There’s the Residential Addiction Counselor who had to convince a medical insurance agent why their patient needed residential care, NOT meetings:
“Residential Addiction Counselor here. We have battles CONSTANTLY with insurance companies who don’t think our clients need care. A few years ago, I had a client who was using meth, IV, daily, and her insurance company came back with, ‘We don’t see the need for residential. She can probably just go to a few meetings, and she’ll be fine!’ I had to do a peer-to-peer review with one of their representatives and practically plead my case. After almost an hour, they finally ‘graciously’ gave me seven days of residential care for her. Which does absolutely nothing. When those seven days were up, I had to go back through the whole process again to get her approved for another seven. Some insurances are better than others, but you definitely know the ones that getting days approved will be an uphill battle. I will say that one of those insurance companies that is nearly impossible to get approval for is UnitedHealthcare.”
17.There’s the nurse whose patient died of infected bedsores because he couldn’t afford the copay:
“Patient dying of infected bedsore needs a hospital bed with a special mattress. He can’t afford the copay for the bed and the mattress so he elected to just go home and die.”—Anonymous
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18.There’s the wound care nurse who is appalled at the lack of coverage for preventative care:
“I work in wound care and it’s the lack of preventative coverage that blows my mind. To prevent venous leg ulcers (blood flow going back to heart is compromised) for people with venous insufficiency, or leg swelling we recommend compression stockings that are generally $60ish a pair. Insurance won’t cover them unless they have an active open wound. Another one is for patients with peripheral neuropathy (numbness, lack of protective sensation) in their feet. They won’t cover custom shoe orthotics and shoes which is around $300-$500 at all if they are not diabetic. Again, something that can prevent them from getting wounds, emergency amputations, loss of the ability to walk, and risk of life-threatening infections. Average cost to heal a venous leg ulcer with each occurrence $10,000 from 2021 data vs $60 preventative stocking. Average cost to heal a neuropathic ulcer $8,000 and if complications arise can easily reach $45,000 in 2021. Vs. $300-$500. It’s not just the curative treatments that are a problem with being denied. It is also the preventative ones.”
And finally…
19.There’s the admissions worker who tried to explain to insurance that they needed stair training for their 80-year-old patient:
“I work in admissions for a skilled nursing facility (inpatient rehab for seniors). I once submitted an authorization for a lady in her mid-80s who had a knee replacement for a week of rehab to get her back to her independence. She needed to be able to navigate five steps to get into her home. At the time she could not do any. Her insurance denied her because she could walk fifty feet (the average length of a house) with a walker. I tried to explain that she needed to be able to do stairs, and they basically said they don’t pay for stair training, and she could sit on her butt and scoot up the steps.”
Let us know your thoughts in the comments below.
Responses have been edited for length/clarity.
