Ask the Expert: When Healthcare Becomes a Battle – Jennifer Tyner
Q: My doctor says I need a procedure, but my insurance company keeps delaying or denying approval. Why does this happen, and what can I do? I feel stuck between my doctor and my insurance provider.
A: This is an important question, and I’m glad you asked and bringing up an issue many Americans have faced or are dealing with now.
For many Americans, health insurance is supposed to provide reassurance during difficult medical situations. More and more, however, patients and families say they’re caught in a stressful and confusing system of delays and denied claims. This happens while people are trying to get the care they need for medical conditions they’re living with right now.
Recently, national news outlets have highlighted growing public concern over insurance denials and the emotional toll they can take on patients. One story featured a man suffering from severe chronic back pain whose physician recommended surgery, only for the procedure to be repeatedly denied by his insurance company while additional treatments were required first.
Unfortunately, his experience is not uncommon.
Many people today say they feel overwhelmed by the amount of paperwork, phone calls, appeals, and waiting it takes to get approval for treatment. For patients already coping with pain, illness, or uncertainty, this is emotionally exhausting and adds to the overwhelm they already feel.
One of the most common reasons for reimbursement delays is a process called prior authorization. This means a healthcare provider must receive approval from the insurance company before certain medications, procedures, tests, or therapies will be covered.
Insurance companies state that prior authorization helps manage healthcare costs and ensures treatments are medically appropriate. But critics argue that the process can create unnecessary delays and prevent patients from receiving timely care.
Claims can be denied for many reasons. Some of the most common are:
- Missing documentation
- Administrative or coding errors
- Out-of-network provider issues
- Treatments considered “not medically necessary”
- Lack of prior authorization approval
In some cases, denied claims are eventually overturned through appeals. However, navigating the appeals process can be confusing and time-consuming, especially for older adults or someone already managing serious health conditions.
What many patients say is most frustrating is the feeling that healthcare decisions are being influenced more by administrative systems than by the recommendations of their doctors.
Families facing chronic illness, cancer treatment, surgeries, or ongoing medical care often describe the process as emotionally draining. Delays in treatment may worsen symptoms, increase anxiety, and leave people feeling angry, helpless and confused.
Healthcare providers also feel the strain. Many physicians report spending significant time completing insurance paperwork and prior authorizations instead of focusing directly on patient care.
For older adults and caregivers, these challenges can be especially difficult. Coordinating communication between doctors, specialists, pharmacies, and insurance companies often becomes a full-time responsibility during periods of illness or recovery. More than one client has said it “feels like a part-time job” just to keep up with appointments, prescriptions and billing.
The question becomes: what can you do when this happens, and can anything make it better, easier or less confusing? The truth is – there are steps you can take to help the system along faster and without quite as many phone trees.
Here are several important steps patients and caregivers can take:
- Keep detailed records of all medical visits, recommendations, and insurance communications.
- Ask providers whether prior authorization is required before scheduling procedures or tests.
- Request written explanations for denied claims.
- Appeal denials when appropriate—many are eventually reversed.
- Ask to speak directly with a case manager or patient advocate through the insurance company.
- Seek assistance from hospital social workers, patient advocacy organizations, or family members when navigating complex cases.
Patients should also remember that persistence matters. Many approvals happen only after additional documentation or appeals are submitted. But they often do happen. It’s easy to feel like the first pushback is the final answer, but that’s not always the case. It’s important to follow up, which isn’t easy but really does help.
The growing conversation around insurance denials reflects a larger question within healthcare today: how do we balance cost management with compassionate, timely patient care?
Most experts agree that greater transparency, clearer communication, and simplified authorization processes could help reduce stress for patients and families. At its core, healthcare should support healing and wellbeing—not create additional barriers during already difficult times.
Behind every denied claim is a real person, like you, trying to receive the care they need. It’s not easy, and it’s certainly not without frustration, but using the tips above might help make it a little more manageable.