A new report released this week is putting a spotlight on how health insurance coverage denials affect Americans in their dealings with doctors, insurance companies and hospitals. Titled around the impact of coverage denials, the report draws on the Commonwealth Fund's 2025 affordability survey of more than 4,500 adults with private insurance, conducted between July and October of last year.
One of the headline findings is the sheer reach of the problem. According to the report, one in five people with private health insurance said that they or a family member had insurance coverage denied in the past year, underscoring how common such denials have become among insured Americans rather than being a rare occurrence.
The denials came at different stages of care. The report found that 13 percent of people said they had an authorization denial even before care was provided, meaning the insurer questioned or refused to cover a service ahead of treatment, adding uncertainty for patients before they had even received care.
For many, the financial consequences lingered well after treatment. The report found that 43 percent of people who had a claim denied said it led to medical debt that they are still paying off, turning a coverage dispute into a long-term burden on household finances long after the medical issue itself.
Despite the stakes, many patients did not challenge the decisions. Only about half of those who experienced a coverage denial appealed, often because they were unsure they had the right to do so or did not think it would make a difference, leaving a large share of denials unchallenged.
Yet appealing frequently paid off. Among those who did challenge a denial, many ultimately received some form of coverage, either for the recommended care or an alternative, and one-third of those who appealed had their bills reduced or eliminated altogether, suggesting that pushing back can change the outcome.
Dr. Elizabeth Potter, who discussed the findings, argued that denials increasingly feel like part of the business model, describing a shift toward insurers' focus on profits for shareholders that pushes them to deny as much as possible as a method of cost control. She added that, as the owner of her own surgery center, she believes hospitals can overcharge patients by a factor of four or five.