Patients Take On Insurers, Bypassing Appeals Process to Get Life-Saving Care
When health insurance companies deny essential care to patients, some are taking matters into their own hands. Elizabeth Nicholas and Donald E. Grant Jr., two patients who faced life-threatening situations when their insurers refused coverage for recommended treatments, decided to bypass the standard appeals process and email the CEOs of their insurance companies directly.
Nicholas was diagnosed with breast cancer at 36 and watched her insurer refuse to pay for chemotherapy. Her oncologist delivered the news, but Nicholas didn't give up. She emailed the CEO of UnitedHealth Group, laying out her case in human terms rather than going through the black box of the standard appeals process.
Grant's situation was equally dire. A fall caused him to lose sensation in his legs, and imaging showed new myelomalacia spreading across four vertebral levels. He now has bilateral foot drop, numbness, and weakness in his lower legs, as well as bowel and bladder problems. His surgeon, Dr. Hyun Bae at Cedars-Sinai, is a leading authority on multilevel cervical arthroplasty and its revision.
Grant's appeal was exceptional due to the level of detail and sophistication it showed. He had help from Claimable, an AI-assisted appeal service founded by Warris Bokhari, which invoked federal regulations and ERISA case law in his 11-page letter. The letter demanded that no algorithm or automated tool be used in deciding his appeal and requested written confirmation of this.
Grant's strategy worked: UnitedHealthcare approved Dr. Bae and the procedure at the in-network rate, clearing the way for the October 14 surgery. Grant credits UnitedHealthcare employees with being responsive and patient during the process.