What We’re Reading: How Insurers Deny Claims; the Development of an ALS Drug


How the insurance industry denies claims; consumers confused by complexity and red tape; and how the ALS drug Relyvrio came to be.

UnitedHealthcare Tried to Deny Coverage to a Chronically Ill Patient. He Fought Back, Exposing the Insurer’s Inner Workings.

Data show that insurers reject about 1 in 7 claims for treatment. One family’s fight for coverage for treatment for ulcerative colitis shows the inner workings of UnitedHealthcare’s procedures for denying claims, according to a story published by ProPublica. Although the insurer claimed the high cost of biologics used to treat this patient’s ulcerative colitis didn’t factor into its denial, recordings of conversations and other documents show that cost was top of mind for those making decisions at United.

How Often Do Health Insurers Say No to Patients? No One Knows.

Another article published by ProPublica looks into insurer companies’ denial rates. Done in collaboration with The Capitol Forum, this review finds there is a lack of transparency about denial rates. Some suggest that between 10% and 20% of claims are denied, but there is limited data and rates vary from plan to plan and across services.

KFF Survey of Consumer Experiences with Health Insurance

Most (58%) people with health insurance say they encountered at least one problem using their coverage in the past year, finds a new KFF survey of consumer experiences with health insurance. About half of insured adults report some difficulty understanding at least one aspect of their health insurance, such as what their insurance will cover (36%), what they will owe out-of-pocket for care (30%), or what their explanation of benefits statement means (30%).

When Dying Patients Want Unproven Drugs

A story in the New Yorker looks at how AIDS activists fighting for access to experimental drugs led to the accelerated approval process and new treatments for ALS. The story interviews ALS patients, doctors, advocates and the two then-college students who had the idea for the recently approved Relyvrio.

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