When a health insurance company refuses to pay for your treatment, most people do exactly what the company is counting on: they give up. They don’t trust the insurer to reverse its own decision, so they swallow the bill or go without the care. But there is a little-known process that can take the decision out of the insurer’s hands entirely… and force the company to pay for what can be lifesaving treatment.
A North Carolina woman named Teressa Sutton-Schulman found it the hard way. Her husband was in a severe mental health crisis and needed intensive psychiatric care, and their insurer, Highmark Blue Cross Blue Shield, kept denying the claims… even after he attempted suicide twice in the span of 11 days, according to ProPublica, which followed the couple’s fight. The instructions for the tool that would finally win their case were buried on page seven of one of those denial letters.
