Sultan: The suffering from health insurance companies' denials

The shocking murder of UnitedHealthcare CEO Brian Thompson opened the floodgates of people sharing their stories of how health insurance companies’ denials have devastated their lives.

One of the most outrageous denials I’ve ever heard came from a woman who reached out to me in 2021 after she had an above-the-knee amputation. Prior to the surgery, she had double-checked with her insurance provider to make sure the prosthetic she needed after the amputation would be covered. Multiple times they assured her it would. After the surgery, they denied the claim. She reached out to me with documentation of all her communication with them. (She had wisely downloaded all the online chats and recorded the phone conversation.) I left messages with whomever I could find as media contacts.

No one ever called me back, but they quickly approved the claim for her prosthetic leg.

She then decided not to share her story publicly, perhaps worried about angering a company whose decisions controlled her ability to function. As egregious as the denial was in her case, I hoped it was an aberration.

But it made me wonder about how many others were scared to speak out about what they have experienced.

Most of us have heard stories of callous and capricious decisions by health insurance providers. I didn’t realize how common and cruel these denials can be until this past week.

I asked a Facebook group of moms if any of them could share a personal experience with a health insurance claim. I was taken aback by the outpouring of responses.

Ashley Berhorst, 43, of Wentzville, was diagnosed with an aggressive breast cancer in February. She underwent 16 rounds of chemotherapy and then a tougher chemo known as the “red devil.” United Healthcare denied her a shot, Neulasta, that is commonly administered during chemo to protect from infection. Her oncologist was stunned. After back and forth between the doctor’s office and a peer-to-peer review board, UHC still denied the shot. The next week, Berhorst ended up in the ER and hospitalized with a fever and low white blood cell count. A fever is a potentially deadly situation for a cancer patient with a port.

“It put me in a very vulnerable position that I shouldn’t have been put in,” she says.

“They don’t care if I die. But my kids do. And my family does.”

She had three more rounds of chemo, and UHC approved the shot after her hospitalization. She survived that close call, but how many others aren’t so lucky?

Jennifer Grotpeter, 57, splits her time between Webster Groves and Lawrence, Kansas. While driving on the highway in May, her vision turned into a kaleidoscope. She made her way over to the shoulder while hitting the guardrail.

“It was terrifying,” she says. Based on her symptoms, her doctor suggested she see a specialist for POTS, a blood circulation disorder. The specialist in St. Louis is not accepting new clients, so she found a POTS clinic at the University of Kansas Medical Center. Anthem Blue Cross Blue Shield would not cover treatment. Grotpeter spent hours on the phone every day for a week with her insurance company.

She waited on hold for hours at a time. Her doctor filled out all the necessary paperwork. She sent reams of faxes of her medical records. No two people on the phone told her the same thing. She asked the representative: “How do people who are not retired do this? Do you just let them be sick?”

When a representative told her to call back the next day, Grotpeter ran out of patience.

“I would rather let this condition kill me than ever call the number on the back of that card again,” she says. She switched to an insurance provider that cost her twice as much but covered her care. Her biggest issue with her POTS is low blood pressure, which can cause a medical emergency while driving.

“Maybe Anthem was trying to cure me by having their total shit ‘customer service’ shoot my blood pressure through the roof,” she says sarcastically.

Laura Pogue, 42, of O’Fallon, Missouri, had a badly needed surgery in 2017 to repair a severe diastasis recti and an umbilical hernia. After giving birth, the fascia that encased her abdomen were shredded. Her abdominal muscles separated so far that she could fit her entire fist in her abdominal cavity. Laying on her side, she could feel her intestines. It caused terrible back pain.

After several meetings between her doctors and Blue Cross Blue Shield, her insurance provider said the surgeries would be covered. After the surgeries, they denied the claims because of the description the surgeon put in the report of how he did the hernia repair.

“It was not considered a complete repair of the hernia,” she says. Pogue appealed the decision. It was denied. Her only option was to hire a lawyer, which she didn’t have the money to do. She fought the insurance company for a total of two years.

“Even when you do your homework and do all the things they tell you to do ... I jumped through all of their hoops, and I did everything right,” she says. She was still stuck with a $10,000 bill that took four years to pay off.

“So many people don’t realize this can happen to you,” she says.

These nightmare scenarios of near death and financial ruin should serve as a wake-up call for legislators, the insurance industry and all of us who put our health in their hands.

CEO Murder Suspect Luigi Mangione From Prominent Maryland Family With Business Empire

Luigi Mangione was arrested Monday in Altoona, Pennsylvania, in connection with the killing of UnitedHealthcare CEO Brian Thompson in what law enforcement has called a "targeted attack." Mangione is from a prominent Maryland family with extensive business interests. The Mangione family is known for developing real estate and running businesses. Relatives expressed shock over the arrest and offered condolences to Thompson’s family. Mangione faces multiple charges, including murder, firearm possession, and forgery, in New York and Pennsylvania.

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