In the United States, having health insurance does not guarantee that you will receive the care you need. Every year, insurance companies reject tens of millions of claims from people seeking all kinds of medical services, ranging from surgeries to MRIs. The same goes for dental care.
A patient who is denied care and tries to push back faces many obstacles. Challenging the insurance company can require filing an appeal with the insurer, requesting an independent medical review or even filing a lawsuit. Patients can also request their claim file, which lets them see all of the documents, notes and phone call audio generated around the case. (Here is more information on requesting your claim file.)
We are also hoping to hear from people working for or with insurance companies, since you know how the system works better than most. Please fill out the below form if you work as a medical director, nurse or customer service representative or have the expertise that can help us understand the health insurance system and its pressures. We are especially interested in connecting with individuals who have experience in or an understanding of the use of artificial intelligence or other algorithms in the claims process.
Doctors and other medical professionals have already begun telling us that they are frustrated by the hours they spend trying to get insurance companies to approve care for their patients. We would like to hear about those experiences as well.
Our team may not be able to respond to everyone personally, but we will read everything you submit. We appreciate you sharing your story, and we take your privacy seriously. We are gathering these stories for the purposes of our reporting and will contact you if we wish to publish any part of your story. See our work so far on this subject by visiting this page.
We are the only ones reading what you submit. If you would prefer to use an encrypted app, see our advice at propublica.org/tips.