Emergency rooms represent the sole remaining accessible entry points to American healthcare. As an emergency medicine doctor in one of the country’s largest cities, I personally witness how insurance claim denials delay diagnoses, cause unnecessary suffering, and escalate expenses by diverting routine medical attention to the most costly environment: the emergency department.
Patients seek our services because we can condense weeks of outpatient procedures into mere hours, bypassing the initial struggle with insurance prior authorizations. In emergency situations, where every second is vital, we provide immediate treatment. However, our ERs are increasingly functioning as America’s de facto outpatient clinics, attending not only to critically ill and injured individuals but also to patients with urgent, non-life-threatening conditions whose insurers have blocked alternative care access.
The health insurance industry in America operates on a problematic business model; they save immense amounts of money when they refuse, or pressure medical professionals to refuse, care. With medical debt ranking among the primary causes of bankruptcy in the U.S., each denied claim can push families closer to financial collapse.
A recent article indicates that almost one in five American households are burdened with medical debt. I have encountered patients whose insurers declined to authorize an MRI — even when scans revealed a severe surgical condition that, if untreated, would have permanently impaired their ability to walk.
Prior authorization is akin to a required permit your physician must obtain from your health insurer before certain treatments or diagnostic tests. What was intended to control superfluous tests and care has evolved into a complex, back-and-forth bureaucratic challenge that can delay essential treatment, intensifying stress and inflating costs.
Internal documents indicate that Cigna doctors rejected care for over 300,000 patients using widespread denials, spending an average of 1.2 seconds on each case. Even more concerning, one out of every four Medicaid requests—the vital safety net program for children, seniors, and low-income individuals—goes unanswered. An analysis of nearly 20,000 Medicaid enrollees showed that those who received a procedural denial were 20 percent more likely to visit the Emergency Department within 60 days.
Some patients have successfully utilized social media as a platform to highlight their situation and compel insurance companies to reverse their decisions. Health policy and management professor Miranda Yaver faced comparable obstacles. After Aetna denied her care, she spent hours on hold without success. Frustrated, she turned to Twitter, tagging the company with her narrative, and watched in astonishment as the company not only responded but .
We must maintain pressure on insurers, fueling this effort with legislative actions that protect patients and intensifying it with persistent public advocacy. This cannot be a fleeting spark; it must expand until the entire system is compelled to change.
Beyond merely celebrating social media usage and relying on hashtags, fundamental change is required. We need clear, patient-friendly appeals processes, and genuine accountability with state and federal governments intervening when these insurers wrongfully deny care.
Insurance companies should provide transparent, real-time dashboards for denial rates and time-sensitive appeal portals. Let’s dismantle the obstacle course that insurance companies have constructed and establish federal safeguards to prioritize patients over unnecessary denials. In a system where insurers can deny care in 1.2 seconds, every moment we delay leaves another patient waiting.
