Philly nurse to testify before federal committee on patient insurance denials

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Why is it so hard for patients to fight health insurance denials – and to access the health care services they need? Those are questions Philadelphia nurse and patient advocate Betty Long will testify about before a federal advisory council in Washington D.C. this week.

Over the last 38 years of working as an ICU nurse, a traveling consultant, a nursing supervisor and now a patient advocate, Long said she’s seen first-hand exactly how much trouble people have with navigating complex health care systems and programs.

“You need so much education to get through the health care system, so much education,” Long said. “And the insurance, that’s a minefield, too.”

Long will testify Thursday before the U.S. Department of Labor’s ERISA Advisory Council, which recommends policies and regulations that apply to private and employer-sponsored health insurance practices and programs.

The exact number of times that private health insurers and plans deny coverage for health care services is unknown, even to the federal government, as most of this data is not made public.

But nearly one in five people reported that they had recently experienced a denied claim in a 2023 KFF consumer survey.

Insurance denials can lead to delayed care or worsening health conditions, according to a July report by the Commonwealth Fund.

But many people don’t even understand why insurance denied their claim, how to appeal a denial or where to go for help, Long said.

“When the insurance company writes the denial letter to the patient or family, it’s not in language that anyone can understand – sometimes we don’t even understand it,” she said. “Insurance companies should have to write things in language that patients understand.”

It’s one of the many reasons why Long founded Guardian Nurses, a national nonprofit based in Flourtown, Pennsylvania, in 2003. The organization has a team of nurses and a social worker who provide in-person patient support and advocacy.

“I often say you wouldn’t enter the legal system without an attorney and you should not enter the health care system without an advocate,” Long said. “And who better to advocate for someone besides a nurse?”

Long said she and her team often help fight these insurance claims and denials. Sometimes, it’s just a matter of tracking down more information in the patient’s medical records and providing the insurance company with more details on why the procedure or medication is medically necessary.