HEALTH INSURANCE DENIALS AND “THE POWER OF THE PRESS”
Since 2025, we’ve been investigating the cases of Florida patients denied insurance coverage for doctor-recommended procedures, including cancer treatments, medications and life-saving surgeries.
In case after case, those denials were reversed only after we started asking questions, with no explanation from insurers.
Watch report from Katie Lagrone
Madeline Rogers of Zephyrhills was denied coverage for colon surgery three times. Mary Barnes, a breast cancer patient in St. Pete, was forced to halt her chemotherapy treatments and Broxley Bunt of West Palm Beach was diagnosed with a brain tumor when he was denied coverage for surgery to get it removed.
These are just a few of the stories we’ve shared as part of our ongoing, award-winning ‘Patient No More’ series.
DENIALS GET REVERSED WITH LITTLE TO NO EXPLANATION
But in each case, the denial was reversed only after our reporting began — and even then, the insurance company offered no explanation for the sudden change.
"I was shocked. I was floored to hear from them so quickly," Rogers said after learning the $150,000 colon surgery would be covered after Investigative Reporter Kylie McGiven contacted Oscar Health about the denial.
"It's a relief, but why the hell do you have to go through this to get them to do what they're supposed to do to begin with?" Mary Barnes questioned after Investigative Reporter Katie LaGrone told her United Healthcare would, in fact, cover her breast cancer chemotherapy treatments after they originally denied it.
United originally claimed her doctor-recommended treatments, which included immunotherapy treatments, do not meet “national cancer guidelines” but then changed the designation to “medically necessary.”
REASONS FOR A DENIAL AND A SUBSEQUENT APPROVAL
Dr. Bill Hennessey is a physician turned patient advocate who helps people appeal insurance denials and negotiate medical bills.
He says most denials fall into three categories:
- Cost of care is too high
- A treatment isn't ‘medically necessary’
- Or a treatment is ‘experimental’
When asked under what conditions most insurance companies reverse their denials, Hennessey was direct.
"It'll happen if, number one, you're right and number two, you complain," Hennessey said.
As for why several denial cases we investigated ended up being reversed with no explanation, Hennessey summed it up like this: "Well, it's one of two things. You're either a miracle worker like Jesus, or you are correct. It is the power of the press. They don't want the negative public relations," Hennessey said.
Federal data recently analyzed by KFF, the leading health policy organization in the U.S., found most health insurance claims are ultimately approved — but the data doesn’t show how many claims are denied first, since insurers only report the final outcome.
That's significant because most patients who are denied never appeal.
Broxley Bunt was initially denied coverage for surgery to remove a meningioma brain tumor because his surgeon was out of network. His insurer, Florida Blue, reversed the denial after Reporter LaGrone started interviewing him from his hospital room where he underwent the surgery anyway.
"I don't think I could have done it on my own," Bunt said in response to the sudden reversal.
Mark Armstrong recently got his blood cancer medication covered after his insurer, Oscar Health, wanted him to pay thousands of dollars up front as part of a “co-pay accumulator” policy.
“I HONESTLY BELIEVE IT’S BECAUSE YOU REACHED OUT TO THEM”
But, according to a federal court ruling, Armstrong should have been exempt from this policy since the medication did not have a generic equivalent. Reporter LaGrone questioned Oscar about the exemption, and only then did the insurer make his medication available at no cost.
His wife, Michele, believes the media scrutiny made all the difference.
"I honestly believe it's because you reached out to them. I think they're scared," she said.
Patient Mary Barnes echoed that sentiment after her denial for chemotherapy treatment was reversed following our phone calls to her insurer.
"I really believe that if you wouldn't be doing what you're doing, they would still be denying me," Barnes said.
HEALTH INSURANCE INDUSTRY RESPONDS (SORT OF?)
In response to questions about how the health insurance industry responds to public scrutiny, a spokesperson for AHIP, the nation's largest health insurance trade group, responded with the following statement:
“Health plans recognize when a claim is denied, the process can be frustrating for patients. In the fragmented and heavily regulated health care system, health plans, providers and drugmakers share a responsibility to make high-quality care easier to navigate for the people we collectively serve. The goal of health plans is always to connect patients to care that is coordinated, timely, evidence-based and as affordable as possible.”
Hennessey said patients must continue to fight and speak up.
"We just got to fight and fight and fight and publicize and publicize and talk to people like you. This is what I call a twisted sister moment. We're not going to take it anymore," Hennessey said.
WHAT TO DO IF YOU’RE DENIED
If you are denied a treatment your doctor recommends, don't assume the answer is final. Appeal the decision, ask questions and don't be afraid to take your story public by contacting the media or taking your story to social media.
Dr. Bill Hennessay shares advice on how to challenge a health insurance denial:
- Make sure to get all your records and itemized bills. Look for inaccuracies and point them out to your insurer.
- Have your in-network physician document that your care is medically necessary. Be willing to pay them for the time they take to put this in writing.
- Appeal your denial and submit your doctor’s letter with your appeal.
- Emphasize your clinical situation and the worst-case scenario for your health if you don’t get the procedure or treatment your doctor is recommending
- If your insurer engages in a peer-to-peer review, make sure the doctor your insurer is using for this review has the same specialty needed for your care. So, if your condition requires a neurosurgeon, then the insurance company should have a neurosurgeon reviewing the case with your neurosurgeon.
- Finally, go public with your denial. Tell your story on social media and your local news station. Get your message and your denial out there!
CONTACT ME!
If you are dealing with an insurance denial for medically necessary treatment that is recommended by your doctor, reach out to Katie below through the contact form:
Share Your Story with Katie
Katie LaGrone focuses on making sure Florida’s laws actually work and her investigations have gotten results. If you know of a policy or law that’s not working how it’s intended, send Katie a message below.
.
Florida memory care facility files for bankruptcy after $1.5M court judgment
A Pasco County memory care facility filed for Chapter 11 bankruptcy weeks after a judge ordered it to pay a $1.5 million award to a resident's family in a wrongful death lawsuit.
