Jessica Mendoza

Ed's doctors gave him all kinds of treatments until finally there wasn't much else to do.

Ed's doctors gave him all kinds of treatments until finally there wasn't much else to do.

His doctors said the best solution would be a liver transplant. But there was a big hurdle Ed needed to clear. Getting approval from his insurance company, Anthem Blue Cross and Blue Shield. But Anthem rejected his claim.

His doctors said the best solution would be a liver transplant. But there was a big hurdle Ed needed to clear. Getting approval from his insurance company, Anthem Blue Cross and Blue Shield. But Anthem rejected his claim.

His doctors said the best solution would be a liver transplant. But there was a big hurdle Ed needed to clear. Getting approval from his insurance company, Anthem Blue Cross and Blue Shield. But Anthem rejected his claim.

Oh, man.

Oh, man.

Oh, man.

The news was especially difficult to hear because Ed's doctors had said that if he didn't get a new liver, he would probably die. In a statement, Anthem said it is committed to, quote, providing members with access to safe, effective, and clinically appropriate medical care. Our decisions are rooted in evidence, not cost. Welcome to The Journal, our show about money, business, and power.

The news was especially difficult to hear because Ed's doctors had said that if he didn't get a new liver, he would probably die. In a statement, Anthem said it is committed to, quote, providing members with access to safe, effective, and clinically appropriate medical care. Our decisions are rooted in evidence, not cost. Welcome to The Journal, our show about money, business, and power.

The news was especially difficult to hear because Ed's doctors had said that if he didn't get a new liver, he would probably die. In a statement, Anthem said it is committed to, quote, providing members with access to safe, effective, and clinically appropriate medical care. Our decisions are rooted in evidence, not cost. Welcome to The Journal, our show about money, business, and power.

I'm Jessica Mendoza. It's Wednesday, May 14th. Coming up on the show, how an insurance denial threw one family into a life-or-death crisis. Say you get sick and go to the doctor. Your doctor gives a diagnosis and prescribes a treatment, like medication or, if it's really bad, surgery. In the U.S., if you have health insurance, your doctor then sends the treatment plan to your insurance provider.

I'm Jessica Mendoza. It's Wednesday, May 14th. Coming up on the show, how an insurance denial threw one family into a life-or-death crisis. Say you get sick and go to the doctor. Your doctor gives a diagnosis and prescribes a treatment, like medication or, if it's really bad, surgery. In the U.S., if you have health insurance, your doctor then sends the treatment plan to your insurance provider.

I'm Jessica Mendoza. It's Wednesday, May 14th. Coming up on the show, how an insurance denial threw one family into a life-or-death crisis. Say you get sick and go to the doctor. Your doctor gives a diagnosis and prescribes a treatment, like medication or, if it's really bad, surgery. In the U.S., if you have health insurance, your doctor then sends the treatment plan to your insurance provider.

The goal is to get the insurance company to agree to pay for the treatment. Five billion health insurance claims are filed in the U.S. every year. If the insurance company approves the expense, great, you go get your treatment. But if insurance denies the claim, then it's up to you, the patient, to pay for it. And a lot of medical treatments cost way more than most Americans can pay out of pocket.

The goal is to get the insurance company to agree to pay for the treatment. Five billion health insurance claims are filed in the U.S. every year. If the insurance company approves the expense, great, you go get your treatment. But if insurance denies the claim, then it's up to you, the patient, to pay for it. And a lot of medical treatments cost way more than most Americans can pay out of pocket.

The goal is to get the insurance company to agree to pay for the treatment. Five billion health insurance claims are filed in the U.S. every year. If the insurance company approves the expense, great, you go get your treatment. But if insurance denies the claim, then it's up to you, the patient, to pay for it. And a lot of medical treatments cost way more than most Americans can pay out of pocket.

Denials are pretty common. According to a recent study by a health policy nonprofit, around 19% of in-network insurance claims are rejected every year. And out-of-network denials are almost twice as high. I asked my colleague Julie Wernow about this. She covers health care. Why do insurance companies say they do this? Why is this the process that's set up?

Denials are pretty common. According to a recent study by a health policy nonprofit, around 19% of in-network insurance claims are rejected every year. And out-of-network denials are almost twice as high. I asked my colleague Julie Wernow about this. She covers health care. Why do insurance companies say they do this? Why is this the process that's set up?

Denials are pretty common. According to a recent study by a health policy nonprofit, around 19% of in-network insurance claims are rejected every year. And out-of-network denials are almost twice as high. I asked my colleague Julie Wernow about this. She covers health care. Why do insurance companies say they do this? Why is this the process that's set up?