Billions of health insurance claims are processed every year, and around 19% of them are denied. Very few people appeal, but those that do have a chance at a different outcome. Jessica Mendoza speaks to one family about the insurance denial that threw them into a life-or-death crisis, and WSJ’s Julie Wernau on the system they navigated. Further Listening: - Even Doctors Are Frustrated With Health Insurance - The Cyberattack That's Roiling Healthcare Sign up for WSJ’s free What’s News newsletter. Learn more about your ad choices. Visit megaphone.fm/adchoices
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Ed Stratton is 65. He lives in St. Louis, Missouri, not far from his daughter, Erin Stratton. Are you guys close, you and your dad? Oh, yes. Can you tell us a little bit about him?
Yeah, absolutely. He has always had the biggest personality. He's really funny, very engaging. He's been in sales his entire career, so he has that very charismatic salesperson personality. He, both my family, my entire family extended and everything is very big into golf.
Ed played golf all the time. He loved being out on the sprawling course. But in late 2023, he started feeling more and more run down. He'd had other health problems in the past, and now it turned out that his liver was failing.
He would just get so sick. He was in and out of the hospital. He was really losing a ton of weight. He was very tired, couldn't eat.
Ed's doctors gave him all kinds of treatments until finally there wasn't much else to do.
It got to a point where There weren't a lot of options. We had gone through what would traditionally be the remedy for the issue that he's having in his liver. And so it got to this point of like, if you get a new liver in his case, all of the problems go away.
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.
We get this denial letter at 4 p.m.
Oh, man.
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