Patients Bypass Insurers, Email CEOs Directly to Overturn Denials

When insurance companies deny claims through traditional channels, some patients are taking their cases directly to the CEO’s inbox — and winning.

Two recent success stories were highlighted by Wendell Potter, a former insurance company executive, in his Substack newsletter Health Care Un-Covered.

“Taking concerns to the top is a strategy more people should utilize,” Potter told MedPage Today. During his time at Cigna, he noted that cases being investigated by reporters were often elevated internally.

“You can be certain that at big insurance companies, there is a group of people around the CEO who are dedicated to high-profile cases and cases that are elevated to the C-suite or to the PR department — and they get special attention,” Potter said.

One of the two cases in Potter’s post was originally covered by journalist Elizabeth Nicholas in Vanity Fair last month.

Nicholas, diagnosed with breast cancer at age 36, faced an insurance denial for the chemotherapy regimen her oncologist recommended after months of treatment. Frustrated, she emailed her insurance company’s CEO and soon received confirmation from the company’s chief scientific officer that the treatment was approved.

The second case involves Donald E. Grant Jr., a 49-year-old with severe congenital cervical stenosis. Following a failed two-level artificial disc replacement that led to myelomalacia, Grant needed surgery with Dr. Hyun Bae, a leading spine specialist at Cedars-Sinai — but Bae was out-of-network.

Using Claimable, an AI-assisted appeal platform, Grant compiled an 11-page legal and medical appeal demonstrating that his insurer had no in-network surgeons with comparable expertise. He cited relevant regulations and requested that the insurer avoid algorithmic review of his case. Grant sent the appeal to UnitedHealth Group’s CEO, copying other executives, legislators, and journalists.

The strategy succeeded — UnitedHealthcare approved the procedure at the in-network rate.

Potter noted that most patients lack knowledge on how to effectively challenge denials. Both Grant and Nicholas invested significant research effort before escalating their cases to company leadership.

Doctors and healthcare professionals, familiar with the system, may benefit from using unconventional approaches like contacting insurance executives directly to advocate for denied treatments, Potter suggested. However, he cautioned that this approach carries risks — frequent escalations could result in providers being dropped from insurance networks.

“If a doctor becomes a frequent squeaky wheel, that could annoy the insurance company… and you could be kicked out of network,” he said. “Insurance companies do that all the time.”

Despite these risks, Potter advises both patients and clinicians to never accept “no” as a final answer. He expects that bringing concerns directly to C-suite executives may become increasingly necessary to ensure patients receive needed care.

While escalating denials to leadership can be effective, Potter emphasized that such measures shouldn’t be required. Eagan Kemp, a healthcare policy advocate at Public Citizen, agreed.

“It is absurd that providers and patients should have to spend so much time trying to get medically necessary care approved and have to go to such lengths as tracking down C-suite officials,” Kemp told MedPage Today, noting that Medicare-for-All is gaining support partly because it would eliminate insurance intermediaries.

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