Hi Reader,

For most people in America, the inner workings of their health insurer are a black box: Requests to cover treatment or pay claims go in, and approvals or rejections are spit out. ProPublica reporters are trying to bring much-needed transparency to this opaque yet highly consequential process.

Since early 2023, ProPublica’s “Uncovered” series has been exposing how health plans refuse to pay for care at the expense of patient well-being. With help from corporate insiders, recordings and internal emails, our team of reporters is revealing how the insurance industry denies coverage to patients, and those articles are inspiring individuals to appeal their cases and regulators to intervene. Eighteen stories and counting have been published in this series alone. ProPublica is able to put so many reporters, data experts, researchers and more on this case because of folks like you. As a nonprofit newsroom, our funding comes from donations.

In this series, our reporters have:

Exposed how health insurers have been breaking the law for years. States have passed hundreds of laws protecting people from wrongful insurance denials. Yet from emergency services to fertility preservation, insurers continued to deny claims despite laws saying they shouldn’t. 

Revealed how the health insurance industry uses algorithms to expedite coverage denials. Reporters found that Cigna, one of the country’s largest insurers, built a system that allows its doctors to instantly reject a claim on medical grounds without so much as opening the patient’s file, leaving the insured with unexpected bills. This system allows Cigna’s staff doctors to reject tens of thousands of claims per month, despite many state laws and regulations that call for insurance company doctors to review patient files and use their expertise to decide whether to approve or deny claims. After our story was published, a congressional committee and state and federal regulators started to scrutinize the legality of Cigna’s system. 

Taken readers inside the world of the insurance industry’s medical directors — doctors who have the sweeping power to decide whether to pay for vital care. In our latest piece, reporting revealed how one of the nation’s largest insurance companies tracks every minute that its staff doctors spend deciding whether to pay for health care, which some said sent the message loud and clear that Cigna valued speed. Dr. Debby Day, who worked at Cigna for nearly two decades, told us that her bosses pressured her to review patients’ cases too quickly and ultimately threatened to fire her if she didn’t get her numbers up. Day said her bosses cared more about being fast than being right: “Deny, deny, deny. That’s how you hit your numbers,” she said. (Cigna described Day as a disgruntled former employee and said it expects its doctors to “perform thorough, objective, independent and accurate reviews in accordance with our coverage policies.”)

Built a free tool to help patients access their own claim files. Have you ever had your claim denied? Federal regulations require most health insurance plans to give people an opportunity to review documents related to their claims for free. But, with the help of our readers, we found a number of major insurers that were not following the law. (Several changed or updated their policies after we reached out.) So we made a free tool to help you obtain information you have a right to see about yourself.

And this work has inspired change. Spurred by our story about an insurer that denied coverage of the only therapy that could have saved the life of a 50-year-old father of two, a Michigan lawmaker introduced a bill in March requiring health plans in the state to cover cutting-edge cancer treatments. 

Our journalists are able to produce these complicated deep dives into a critical aspect of this country’s health insurance system thanks to our supporters. Today, I’m asking you to make a donation of any amount and support this important work. We’ve got more stories to come in this series, not to mention the dozens of other investigations in the works right now. If you’re in a position to do so, I’d be grateful if you joined us today. 

Thanks so much,  

Jill Shepherd  

Proud ProPublican