This spring, a team of NBC News reporters began digging into complex insurance systems — including health care, homeowners’ insurance and beyond — that leaves millions of Americans desperate. What they found, through conversations with policy holders, communications with insurers and reviews of records, was startling.
Health insurance was a particular focus for the team. They interviewed dozens of patients, doctors and advocates, as well as examined hundreds of pages of medical and insurance records. They found that insurance companies regularly deny claims for medical care, forcing patients with cancer and other diseases or health conditions into protracted battles to receive critical treatments. Multiple doctors revealed to our reporters that insurance denials are worse than ever as the use of prior authorization, which often requires patients or their providers to get permission before procedures or treatment, has ramped up in recent years.
Eric Tennant, a cancer patient from West Virginia, was one of those, but for him, the consequences were tragic. His insurer declined to cover a new, noninvasive procedure that has shown promise destroying tumors in the liver that would slow, though not cure, his stage 4 cancer. As his family fought the insurance company, his health took a turn for the worse. After NBC News reached out to the insurer, West Virginia’s Public Employees Insurance Agency, it changed course. By then, Tennant was no longer considered a viable candidate for the treatment. He died in September.
The investigation
- Full Cost of Denial investigation
- How some denials were reversed
- Spotlight: The case of John Middleton
The Tennant case was one of several in which insurance companies abruptly reversed a decision to deny coverage after hearing from NBC News. An insurance company twice refused to cover the costs of spine surgery for an 18-year-old Texas woman diagnosed with degenerative disc disease — until NBC News reached out. After repeated denials, the family of an 8-year-old girl in need of surgery on her left ear to correct a congenital condition pulled money out of a 401(k) to help cover the roughly $100,000 cost. But on the day of the surgery, their insurance company granted their request to use in-network benefits for an out-of-network provider — a decision the family attributed to NBC News seeking answers from the insurer.
As one doctor said in a different story about a 2-year-old girl being denied coverage for medical equipment to help her deal with a rare neurological disorder: “These denials force parents to fight for things no parent should have to.”
The situation is also bad for those in need of mental health treatment. In Michigan, a 16-year-old boy with depression was rushed to the emergency room after he tried to take his own life in February. At the urging of a doctor, his parents then placed him in a residential treatment facility. But their insurance company determined that a stay at the facility was “not medically necessary” and therefore refused to cover the costs, forcing his parents to sell prized possessions and take out a high-interest loan for $10,000.
NBC News reporters found that recent industry trends have hurt Americans in other ways. The buying up of hospitals and doctors’ offices by private equity firms and other companies has impacted patient care and costs. But there is more to the story. An investigation into the Cleveland Clinic, the Ohio nonprofit ranked among the top hospitals in the world, found that patients have been receiving unexpected bills from doctors’ offices under its umbrella. The new costs were “facility fees” — charges that hospitals used to apply only to people with inpatient stays and emergency room visits. As major health systems snap up increasing numbers of doctors’ offices, more people are being charged these fees for routine appointments in outpatient clinics. The Cleveland Clinic defended the facility fees saying that they align “with government regulations and industry guidelines” and that they aren’t the only hospital that charges them.
It’s not just patients who are being affected. The case of a pediatric neurosurgeon in New Jersey demonstrates how doctors increasingly have to wage their own behind-the-scenes battles with insurance companies in order to receive reimbursements. A division of the insurance giant UnitedHealth Group halted all reimbursements to doctors like Catherine Mazzola after it experienced a massive hack in February 2024. To stay afloat, Mazzola accepted a loan offered by a UnitedHealth subsidiary but, months later, United abruptly insisted that she repay the loan in full. And when she couldn’t, the insurer began depositing reimbursement checks drawn up for her into its own bank account, according to records shared with NBC News (UnitedHealth Group declined to comment). Her experience, antitrust experts say, lends credence to concerns that UnitedHealth Group’s acquisitions of an array of health care operations have given it too much power over patients and the doctors treating them.
“You’ve got physicians looking out for hundreds and thousands of families, and you’ve got this big corporate entity exerting as much financial power as it can, just because it can,” said Josh Bengal, staff counsel at the Medical Society of New Jersey.
Read and watch these stories in the NBC News series Cost of Denial.
