Jessica Mendoza

Ed's doctors determined that he couldn't survive at the rate he was going. That's when they turned to emerging research that showed the best course of action for patients like Ed was a liver transplant. They did an extensive assessment that showed he was the right candidate for this kind of surgery. And then the doctors submitted the paperwork to the insurance company.

Ed's doctors determined that he couldn't survive at the rate he was going. That's when they turned to emerging research that showed the best course of action for patients like Ed was a liver transplant. They did an extensive assessment that showed he was the right candidate for this kind of surgery. And then the doctors submitted the paperwork to the insurance company.

Ed's doctors determined that he couldn't survive at the rate he was going. That's when they turned to emerging research that showed the best course of action for patients like Ed was a liver transplant. They did an extensive assessment that showed he was the right candidate for this kind of surgery. And then the doctors submitted the paperwork to the insurance company.

It was in May that Anthem rejected Ed's claim. It sent him a letter saying his plan didn't cover care that was, quote, investigational and not medically necessary.

It was in May that Anthem rejected Ed's claim. It sent him a letter saying his plan didn't cover care that was, quote, investigational and not medically necessary.

It was in May that Anthem rejected Ed's claim. It sent him a letter saying his plan didn't cover care that was, quote, investigational and not medically necessary.

So what kind of explanation do patients typically get when they get a denial? Very little explanation.

So what kind of explanation do patients typically get when they get a denial? Very little explanation.

So what kind of explanation do patients typically get when they get a denial? Very little explanation.

Meanwhile, Ed was declining further. A big problem was that his liver kept getting infected. And timing is critical when it comes to transplants. You can't be so sick you won't recover from the surgery. If you get that sick, then you could be taken off the recipients list. Here's his daughter Erin again.

Meanwhile, Ed was declining further. A big problem was that his liver kept getting infected. And timing is critical when it comes to transplants. You can't be so sick you won't recover from the surgery. If you get that sick, then you could be taken off the recipients list. Here's his daughter Erin again.

Meanwhile, Ed was declining further. A big problem was that his liver kept getting infected. And timing is critical when it comes to transplants. You can't be so sick you won't recover from the surgery. If you get that sick, then you could be taken off the recipients list. Here's his daughter Erin again.

Was there any concern that, you know, your dad was going to run out of time?

Was there any concern that, you know, your dad was going to run out of time?

Was there any concern that, you know, your dad was going to run out of time?

Ed's medical team disagreed with Anthem's denial because the doctors were looking at emerging research that said a transplant could work. So they appealed. And as part of that process, they submitted additional information to the insurance company. I asked Julie about how that appeals process works.

Ed's medical team disagreed with Anthem's denial because the doctors were looking at emerging research that said a transplant could work. So they appealed. And as part of that process, they submitted additional information to the insurance company. I asked Julie about how that appeals process works.

Ed's medical team disagreed with Anthem's denial because the doctors were looking at emerging research that said a transplant could work. So they appealed. And as part of that process, they submitted additional information to the insurance company. I asked Julie about how that appeals process works.

Ultimately, Ed's medical team filed several rounds of appeals to Anthem. The information they submitted included those recent studies showing people like Ed did well after a transplant. In mid-June, Ed got the final decision. This time, it was from that third-party organization that Anthem had selected to review his case. It was yet another no. We asked Anthem about that final denial.

Ultimately, Ed's medical team filed several rounds of appeals to Anthem. The information they submitted included those recent studies showing people like Ed did well after a transplant. In mid-June, Ed got the final decision. This time, it was from that third-party organization that Anthem had selected to review his case. It was yet another no. We asked Anthem about that final denial.