One thing stands out when I reflect on the hundreds of “peer-to-peer” appeal calls I’ve made over the past decade. I have never failed to
overturn the denial.
It is beyond egregious that the insurance companies have been allowed to get away with this for so long. The companies don’t see the consequences of their denials or what the appeals cost us.
For physicians, appeals cost time and energy. It takes us away from other patients, who suffer the stress and inconvenience of extra waiting. And the gaslighting of our medical expertise contributes to the ongoing epidemic of physician burnout via moral injury.
For the patients who receive an initial denial, even when the appeal is successful, it causes the harm and
suffering of being told their care might not be covered and wondering how they will pay for treatments necessary to save their lives. Will they face such impossible choices as selling their home and going bankrupt to afford their cancer treatment? Choosing
between food or medicine? It forces them to confront the reality that our medical system doesn’t consider them inherently “worthy” of care. Even after we win the appeal, these mental harms cannot be undone.