Categories: HealthcareNews

Coverage Denied, Lives Disrupted: Real Patients and Real Consequences in a Broken Appeals System

FacebookFacebookTwitterTwitterEmailEmailLinkedInLinkedInWhatsAppWhatsAppMessengerMessengerFlipboardFlipboardGmailGmailTelegramTelegramShareShare

TOWSON, Md., May 8, 2025 /PRNewswire/ — Join the Association for Healthcare Denial and Appeal Management (AHDAM) on May 21st at 2:00 PM EST for a live roundtable discussion. This event will feature two patients sharing their experiences of being unjustly denied coverage by major insurers. Don’t miss this important conversation!

In this special edition of AHDAM’s ongoing educational webinars, two remarkable women share their stories of being denied life-saving treatment by their insurers—despite meeting all published coverage criteria. Tiffany Ferguson, a young mother in remission from Hodgkin lymphoma, had her Keytruda therapy abruptly cut off mid-treatment by CareFirst/CVS, citing arbitrary limits and unsubstantiated policy language. Similarly, Anna Hocum, who battles severe Alpha-1 Antitrypsin Deficiency, was forced to pay $100,000 out-of-pocket over the course of a year while UnitedHealthcare repeatedly denied her coverage based on non-existent criteria. Shockingly, a year later, UnitedHealthcare reversed its decision and approved the same therapy after a second physician submitted identical documentation – and perhaps more tellingly after public pressure was applied and her employer’s HR department was compelled to intervene under its fiduciary duty. These stories highlight the urgent need for accountability and transparency in healthcare coverage decisions.

These two incredible stories highlight a systemic problem in healthcare: payers disregarding plan language and legal obligations under ERISA (The Employee Retirement Income Security Act), while patients bear the medical and financial consequences. This roundtable discussion will explore what went wrong, how both women ultimately prevailed, and the legal and strategic tools that helped them succeed.

Led by R. Kendall Smith, Jr., MD, SFHM, ACPA-C, Chief Medical Officer of AHDAM and Payerwatch Inc., this session will be especially relevant for clinicians, benefit administrators, plan sponsors, and patient advocates navigating unjust denials.

Free registration HERE

Media contact: Erik Christensen, echristensen@payerwatch.com

View original content to download multimedia:https://www.prnewswire.com/news-releases/coverage-denied-lives-disrupted-real-patients-and-real-consequences-in-a-broken-appeals-system-302450067.html

SOURCE Association for Healthcare Denial and Appeal Management

Staff

Recent Posts

NextGen Healthcare Welcomes Madison Dearborn Partners as New Investment Partner and Announces Planned Leadership Succession

MDP Completes Acquisition of Significant Ownership Position in NextGen Healthcare and Partners with Thoma Bravo…

47 minutes ago

Rocketseed launches essential email signature guide for healthcare organizations

New resource helps healthcare providers improve branded communication, ensure HIPAA compliance, and boost patient engagement…

50 minutes ago

Hospital PMI® at 52%; May 2025 Hospital ISM® Report On Business®

TEMPE, Ariz., June 6, 2025 /PRNewswire/ -- Economic activity in the hospital subsector expanded in…

50 minutes ago

Infisical Secures $16M Series A to Redefine Enterprise Secrets, Identity, and Access Management

Open-source leader democratizes enterprise-grade secrets management for fastest-growing startups, Fortune 500 enterprises, and nation-states. SAN…

50 minutes ago

Choctaw Nation and Healthy Together Launch Streamlined Summer EBT Program in Just Six Weeks

MIAMI, June 6, 2025 /PRNewswire/ -- Healthy Together, a leading provider of health and human…

50 minutes ago

Improved Pharma Expands Footprint at Kurz Purdue Technology Center, Now Occupying Over 5,500 Square Feet

Fifth expansion since 2020 reflects growing demand for advanced pharmaceutical analysis and development services. WEST…

50 minutes ago