When patients fight health insurance denials.
State and federal insurance regulators report that insurers deny one in seven insurance claims. Many patients accept the insurance company's denial, with only 0.1% formally appealing those decisions. However, when UnitedHealthcare denied payment for Christopher McNaughton's treatment of severe ulcerative colitis, he and his parents fought back.
Christopher McNaughton was a sophomore at Penn State College; at 6 foot 4 inches, he played on the college basketball team. Halfway through his sophomore year, he began to suffer from debilitating ulcerative colitis. He had to leave school because he was essentially homebound, as he spent most of his time in the bathroom or curled up on the couch in pain. His family physician tried all the standard treatments for ulcerative colitis, and nothing gave him relief.
A gastroenterologist at the Mayo Clinic eventually developed a treatment that relieved his symptoms and allowed Chris to begin to lead a normal life. However, the treatment was very expensive. Chris was insured through UnitedHealthcare as a student at Penn State College. United denied payment for the only treatment that was keeping Chris alive. His parents went through the formal appeals process and were denied over and over again. Then they decided to sue UnitedHealthcare. The court filings showed the inner workings of the insurance company's efforts to deny needed care. Read the full story in Family Practice News.