Challenges in U.S. Health Insurance: AI, Claims and Patient Impact

Property & Casualty
Health Insurance Claims Patient Advocacy Regulation Mental Health Healthcare Costs
Dec 31, 2025

This spring, an investigative effort by NBC News revealed significant challenges within the U.S. health insurance system, focusing on AI-driven prior authorization delays and claim denials. The report highlighted the complex regulatory compliance requirements that leave policyholders in prolonged disputes over necessary medical treatments.

Impact of Claim Denials on Patients

Insurers often reject claims for essential medical care, worsening cases for those with severe conditions like cancer. The increasing reliance on prior authorization processes complicates treatment access, and healthcare providers report intensifying impacts on patient care and claim resolutions.

One prominent case involved Eric Tennant, a cancer patient whose insurance carrier initially denied coverage for a critical liver tumor procedure. Though the West Virginia Public Employees Insurance Agency reversed its decision after media intervention, the delay tragically resulted in Tennant missing timely care, leading to his passing in September.

Media's Role in Overturning Denials

NBC News found multiple instances where media scrutiny catalyzed positive outcomes. In Texas, an appeal coupled with media attention secured approval for a young woman's spine surgery. Similarly, urgent media inquiries enabled a family in financial distress to receive last-minute insurance approval for their daughter's ear surgery on the procedural date.

The industry dynamics force families into dire financial decisions and spotlight pressing issues within insurance operations. Mental health treatments face similar hurdles; in Michigan, a teen's residential depression treatment was denied coverage, pushing his family towards financial improvisation.

Trends and Provider Challenges

The industry landscape is also shaped by private equity acquisitions of hospitals, affecting patient costs. Patients at the Cleveland Clinic now face facility fees even for routine appointments, reflecting industry shifts in patient billing practices aligned with current regulatory compliance.

Healthcare providers encounter difficulties due to such trends, exemplified by a New Jersey pediatric neurosurgeon affected by delayed reimbursements following a UnitedHealth Group data breach. This incident exemplifies the financial strain and operational challenges faced by providers amidst payer-provider negotiations.

Amid rising tensions between insurance carriers and healthcare providers, industry experts continue to scrutinize this balance of power, which critically influences patient outcomes and the working conditions of providers.

Rich Schapiro of NBC News provided these insights in the ongoing series "Cost of Denial."