Denied Care, Divided Nation: How America Fails Its Sickest Patients—and the People Fighting Back

October 14, 2025

A ProPublica investigation reveals how insurance companies across America are denying necessary medical care to patients, leaving families devastated and struggling to navigate complex appeal processes. The Affordable Care Act expanded the right to external appeals, but these protections remain uneven across states with many patients unaware of their options. State-based consumer assistance programs have become crucial resources for patients fighting denials, though only about 30 states operate such programs, leaving millions without adequate support.

Who is affected

Patients and families across America who receive denial letters from insurance companies
People experiencing mental health crises, like the North Carolina couple featured in the ProPublica investigation
Consumers in approximately 20 states without fully funded consumer assistance programs
Individuals who lack knowledge about external appeals processes
Patients who are too exhausted, frustrated, or ill to navigate the complex appeals system
Americans who give up on appealing denials due to the complicated and unclear process

What action is being taken

State-based consumer assistance programs in about 30 states are currently guiding patients through internal and external appeals processes
Maryland's Health Education and Advocacy Unit is serving as a lifeline for residents struggling with denied care
New York's Community Service Society advocates are drafting detailed appeals for patients, sometimes creating 15-20 page documents after reviewing thousands of pages of medical records
State agencies in California, Georgia, Illinois, New York, Pennsylvania, Maryland, Virginia, and the District of Columbia are actively operating consumer assistance programs through various departments
Independent physicians are reviewing and sometimes overturning insurance companies' denial decisions

Why it matters

Insurance denials can leave patients without critical medical care, potentially leading to worsened conditions or death
The appeals process is deliberately complex, with information about external reviews often buried deep in denial letters
Even with legal protections in place from the Affordable Care Act, insurance companies have found ways to weaken the system
Most people don't know their rights or where to turn for help when facing a denial
Consumer assistance programs have proven effective at helping patients navigate appeals and secure coverage
Without expert support, many patients simply give up fighting for coverage they're entitled to
Successful appeals can result in significant financial relief, as seen in the case where over $70,000 in care was covered after an independent review

What's next

No explicit next steps stated in the article

Read full article from source: The San Diego Voice & Viewpoint