⚠️ This article reviews a Wall Street Journal piece currently behind a paywall. You can view the original here, but note that a subscription may be required.
Every year, there are over 850 million denied health insurance claims in the United States—an astonishing figure that reveals how many people face frustrating, confusing, and at times life-threatening barriers to getting the care they need.
Even more shocking? Less than 1% of denied health insurance claims are appealed. And yet, of those who do appeal, up to 75% win.
A recent report by the Wall Street Journal shines a light on these numbers and the people behind them—families like the Becks in Georgia or patients like Edward Stratton, who fought through bureaucratic red tape to access life-saving treatments.
The Hidden Toll of Denied Health Insurance Claims
Denied health insurance claims aren’t just an inconvenience. They can derail treatment plans, drive families into medical debt, and create emotional trauma.
In the case of Edward Stratton, a 65-year-old cancer survivor, denial of a liver transplant by Elevance Health could have cost him his life. It wasn’t until he appealed—backed by documentation, data, and public pressure—that the decision was overturned.
He later told the WSJ: “This appeal saved my life.”
This story is not uncommon. But many patients never reach that breakthrough moment. Most don’t even know how to start the appeals process.
Why So Few People Appeal
The WSJ article highlights a critical issue: a sense of futility. Many patients feel overwhelmed, lack time, or are simply unaware that appeals are even possible. And for those battling serious illnesses, the burden of paperwork and follow-ups becomes too much.
“Because a lot of people won’t appeal, won’t call, don’t have the knowledge to sit on the phone—a lot of those go away,” said Dr. Ezekiel Emanuel, an oncologist and medical ethicist.
Insurers know this. The process is designed to be dense and daunting. But knowing your rights and how to fight back is powerful.
A Case Study: The Beck Family and PANS
The article tells the powerful story of April and Justin Beck, whose daughter Emily suffered from a rare neurological condition called PANS. After years of misdiagnoses and unsuccessful treatments, they found a doctor who could help.
But UnitedHealthcare denied the treatment, calling it medically unnecessary—even with supporting studies, doctor recommendations, and case precedent.
The Becks didn’t give up. They worked with the doctor, gathered documentation, involved a patient advocacy platform, and submitted multiple appeals. They even copied UnitedHealthcare’s CEO and state officials.
Eventually, the insurer reversed its decision. Emily began her infusion therapy.
The System Isn’t Built to Help You—But You Can Fight Back
This WSJ report makes one thing very clear: insurance denials are not final. You can appeal. You should appeal.
What many people don’t realize is that federal law protects your right to challenge health insurance decisions, and tools like the Patient-Provider Dispute Resolution process and independent review organizations are available to you.
💡 Need help getting started? Our Education Center has guides on how to appeal a denied claim, understanding your medical bill, and patient advocacy.
Tips for Appealing a Denied Health Insurance Claim
If your insurer says “no,” here’s what you can do:
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Read the denial letter carefully – It should explain the reason and whether it’s medical necessity, lack of prior authorization, or coding error.
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Contact your provider – Doctors can help clarify medical necessity and supply supporting documentation.
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Use data and case examples – Refer to research, successful appeals, and any similar precedent.
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File a formal appeal – Include a detailed letter, supporting records, and clear justification.
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Escalate if needed – After internal appeals, you can request an external review through state or federal programs.
Final Thoughts
Denied health insurance claims can seem like a dead end—but they’re not. You have the right to challenge these decisions, and as this article reveals, many people who do, win.
Don’t let confusion or exhaustion stop you. The system may be complex, but you’re not alone. The Becks, Strattons, and countless others are proof that fighting back can literally save lives.
🔗 Visit the original WSJ article here (paywall)
