Coverage Denied, Lives Disrupted: Real Patients And Real Consequences In A Broken Appeals System

(MENAFN- PR Newswire) 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, [email protected]

SOURCE Association for Healthcare Denial and Appeal Management

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