Straight to the Top: Patients Email Insurance CEOs Over Care Denials

When insurance companies deny claims made through traditional channels, some patients have taken their cases directly to the CEO’s inbox.

Two patients recently had success with emailing insurance company CEOs, and their stories were highlighted by Wendell Potter, a former insurance company executive, in his Substack newsletter Health Care Un-Covered.

Taking concerns to the top is a strategy more people should utilize, Potter told MedPage Today. Back when he worked at Cigna, he said, cases that were being looked into by a reporter were elevated.

“You can be certain that at big insurance companies, there is a a group of people around the CEO who are dedicated to high-profile cases and cases that are elevated to the C-suite or to the PR [public relations] department — and they get special attention,” Potter said.

Indeed, one of the two success stories in Potter’s post was brokered by a journalist. Elizabeth Nicholas wrote about her experience fighting an insurance denial in Vanity Fair last month.

Nicholas was diagnosed with breast cancer at 36. After months of treatments, her insurance company refused to cover the type of chemotherapy her oncologist recommended.

Nicholas was understandably fed up and emailed her insurance company’s CEO. She soon had a message from the company’s chief scientific officer saying the treatment was approved.

A second example is Donald E. Grant Jr., a 49-year-old with severe congenital cervical stenosis. A surgeon performed a two-level artificial disc replacement, which failed to adequately decompress his spinal cord, and months later Grant developed myelomalacia.

Grant had a surgery scheduled with Hyun Bae, MD, a spine surgeon at Cedars-Sinai in California who is the leading expert on Grant’s condition — but Bae wasn’t in-network, though everything else in the operation was.

Grant used Claimable, an artificial intelligence (AI)-assisted appeal platform, to help him put together an 11-page legal and medical appeal explaining that his insurance doesn’t have any in-network surgeons with comparable qualifications, citing relevant regulations and asking that the insurer not use any algorithms to determine his case.

He sent it to UnitedHealth Group’s CEO and copied other company leaders, legislators, and journalists.

This strategy worked for Grant: UnitedHealthcare approved the procedure with Bae at the in-network rate.

Potter pointed out that few patients know how to fight a denial in the first place. For both Grant and Nicholas, getting their care approved took a lot of research before putting company leadership on blast.

Doctors and other healthcare professionals may have an advantage in knowing the system, so they may want to consider using non-traditional means like emailing insurance leaders to fight their patients’ denied claims, Potter said. At the same time, he acknowledged this can carry some risk.

“If a doctor becomes a frequent squeaky wheel, that could annoy the insurance company … [and] you could be kicked out of network,” he said. “Insurance companies do that all the time.”

Regardless, Potter’s advice for both patients and clinicians is to never take “no” as a final answer. He cautioned that it might become more necessary for doctors to bring their concerns to the C-suite for greater assurance that their patients will get the care they need.

While escalating insurance denials to leadership can be an effective strategy, Potter emphasized that it shouldn’t be necessary. Eagan Kemp, a healthcare policy advocate at Public Citizen, concurred.

“It is absurd that providers and patients should have to spend so much time trying to get medically necessary care approved and have to go to such lengths as tracking down C-suite officials,” Kemp told MedPage Today, adding that Medicare-for-All is gaining traction in part because it would cut out middlemen.