Who Decides If You Live or Die? The Truth About Insurance Claim Reviewers
Imagine this: You’re diagnosed with an aggressive form of cancer. Your doctor urgently prescribes a breakthrough treatment, something that could save your life. But before you can begin, your insurance company needs to sign off. Days pass. Then weeks. And finally, a letter arrives with one word: Denied.
You might assume that this life-or-death decision was made by a team of experienced medical professionals. But in reality, it was likely made by someone with no medical degree, no patient experience, and no accountability, possibly a call center employee following a script.
The Hidden Truth: Your Health Decisions Are in the Hands of Non-Medical Staff
While most people believe their insurance claims are carefully reviewed by licensed physicians, the truth is far more disturbing. Many decisions about your care are made by non-clinical personnel, some without any healthcare background at all.
✅ Fact: A 2022 investigation revealed that many prior authorization requests are reviewed by insurance clerks with no formal medical training, yet they regularly override physicians' recommendations.
✅ Fact: A whistleblower at UnitedHealthcare exposed internal pressure to deny claims, regardless of medical necessity.
✅ Fact: In many cases, artificial intelligence algorithms are now automatically rejecting claims without a single human reviewing the case.
Real Stories of Denial and Death
The consequences of this broken system are tragic and real:
💔 A 45-year-old father of three was denied a life-saving cancer drug. His appeal was approved after he died.
💔 A woman in diabetic ketoacidosis was denied insulin by a non-medical reviewer who insisted she “try diet and exercise first.”
💔 Physicians like Dr. Glaucomflecken, a well-known healthcare advocate, have spoken out about being forced to beg insurers for approvals for even routine care.
Why Does This Happen? Follow the Money.
Insurance companies are legally obligated to maximize profits for shareholders. That means spending less on your care, even if it means delaying or denying treatment.
💰 In 2022, the top five U.S. insurance companies brought in $69 billion in profit while denying millions of claims.
💰 Denials save money. Some insurers even incentivize employees with bonuses for rejecting the most expensive treatments.
💰 The system is designed to wear patients down. If you're too sick to appeal a denial, the insurer saves even more.
It Doesn’t Have to Be This Way
We can change the system if we act together:
🚨 Require that only licensed physicians review and approve or deny care, not untrained staff or algorithms.
🚨 Ban automatic denials and AI-based rejection systems that prioritize cost savings over patient lives.
🚨 Pass laws that allow patients to sue insurers directly when wrongful denials cause harm or death.
Join the Fight to Reform Healthcare
We are building a political action committee (PAC) to take on the insurance industry and fight for patients’ rights.
✔️ Elect lawmakers who will overhaul the prior authorization process
✔️ Expose corruption in the claims system
✔️ Fund lobbying for transparency and accountability
Here’s How You Can Help:
🔗 Donate to support legislative and grassroots action
🔗 Share your story if you’ve been harmed by a denial
🔗 Sign up for updates and help us build the pressure for change
👉 No one should die because a call center worker or algorithm said ‘no.’ It’s time to stand up and demand a healthcare system that puts patients, not profits, first.
Join the movement today.
By Ashley G.
