Denial
Denial
Denial
That was the reoccurring theme as patients, doctors, school psychologists, and health care administrators recounted horror story after horror story of private health insurance companies (Aetna and Cigna were mentioned a lot) denying claim after claim, in the hopes that the person looking for payment of services would give up, to Arizona Attorney General Kris Mayes and the two lawyers from her office she brought with her to a town hall covering the subject of Health Insurance Claim Denials at the Gilbert Public Library on Greenfield Road.
Noting an average denial rate of over twenty percent for health care service and a twenty five percent increase in denying prescription drug coverage from 2016 to 2023, Ms. Mayes noted that this proliferation of denials, citing cases of people she knew including her sister, is a “great and serious problem” and expressed “concern that some health insurance companies maybe participating in potentially unlawful practices.”
After hearing the heart wrenching tales recounted by the attendees she promised that she would have her lawyers look into whether these health insurance companies have violated the Arizona Consumer Fraud Act, saying “It’s about damned time we had an Attorney General that fought for this.”
The Horror and Heart Wrenching Stories Told at the Town Hall.
Most of the stories told by the attendees to Attorney General Mayes and her two legal subordinates largely pertained to the theme of the cruel bureaucratic methods health insurance companies issue immediate denials to claims and then embark on a strategy of stringing these patients along with their health care providers for months in the hopes they will go away.
One representative of the Mayo Clinic spoke about about how insurance companies game the system by having a prearranged number of hours to contest denials.
One other health care provider detailed how insurance companies deliberately deny health care entities like rural clinics and hospitals who do not have the proper staffing to contest the denial findings.
Another provider spoke about patients, after being denied their request for affordable prescriptions, having to wait 180 days to appeal a second time after being turned down the first time.
A parent talked about the recent announcement by the Arizona Department of Developmental Disabilities mandating new restrictions on his child’s care which could cause irreparable and catastrophic harm.
One patient, a breast cancer survivor recounted how she was denied for chemotherapy and was rebuked for going to urgent care with the insurance company issuing a letter saying that she had a stomach ache and should have gone home. Fortunately, they did cover for her mammogram and breast cancer surgery.
One patient, a 65 year woman, said the health insurance company finally addressed her needs after reporting them to the Better Business Bureau.
Another patient, an 83 year old woman who had to pay the bulk of her two son’s kidney transplants, said she got traction from the health insurance company after accusing them with the magic words of acting in “Bad Faith.”
Several of the health care administrators and providers, including a school psychologist, told everyone that there has been a profound spike in denials over the last month, including for children who need medications for their behavioral care.
Many of them say the denials are coming from A.I. mechanisms which could coincide with the announcement of the Dr. Oz and the Trump government of starting a pilot program in six states, including Arizona, where A.I. would determine if claims would be approved.
Several of these people expressed frustration that there were no incentives for the health insurance companies to serve their clients with one person saying “There’s no penalty for being jerks.”
The breast cancer survivor likened the appeals process to being in a “Three Stooges” skit.
Another called the process “Denial Purgatory.”
One person said the insurance companies, after not made their financial goals in 2024, were upping the number of denials in 2025 to make up for the prior year shortfall.
The Arizona Consumer Fraud Act Explained.
Closing out the event, Attorney General Mayes said her lawyers at her office would be looking into whether the private health insurance companies violated the Arizona Consumer Fraud Act by committing either:
- Fraud.
- Deception, perception, misrepresentation.
- False pretense.
- False promise.
- Concealment oppression, suppression.
Afterward the Attorney General, her colleagues, and staff spoke with several of the guests and took their information for the next stage in the investigatory process.
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