Jessica Mendoza

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?

But from the perspective of someone hoping to get a procedure approved and their loved ones, the situation can feel very personal. Ed Stratton's health problems started back in 2019 when he was diagnosed with colorectal cancer. To treat that, he underwent surgery and chemotherapy. Here's his daughter Erin again.

But from the perspective of someone hoping to get a procedure approved and their loved ones, the situation can feel very personal. Ed Stratton's health problems started back in 2019 when he was diagnosed with colorectal cancer. To treat that, he underwent surgery and chemotherapy. Here's his daughter Erin again.

But from the perspective of someone hoping to get a procedure approved and their loved ones, the situation can feel very personal. Ed Stratton's health problems started back in 2019 when he was diagnosed with colorectal cancer. To treat that, he underwent surgery and chemotherapy. Here's his daughter Erin again.

then, in the late summer of 2023, Ed started feeling sick again. It was his liver. Colorectal cancer often spreads to the liver, so his doctors started treatment. But that caused other problems.

then, in the late summer of 2023, Ed started feeling sick again. It was his liver. Colorectal cancer often spreads to the liver, so his doctors started treatment. But that caused other problems.

then, in the late summer of 2023, Ed started feeling sick again. It was his liver. Colorectal cancer often spreads to the liver, so his doctors started treatment. But that caused other problems.

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.