12/15/2025
This struggle is all too real.
First, Life-changing or life-saving medications should not be this hard to access or afford.
If an insurer denies a treatment your doctor says is medically necessary, you have rights. Under federal ACA law, families can request an external review by an independent doctor and the decision is binding. Since 2018, Kansas has overturned 54% of denied claims requesting review.
There is help. Finding it and sharing it is part of our mission.
If you or someone you know is facing an insurance denial, please read this article or contact the Kansas Insurance Commissioner to request a review.
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When insurance twice refused to cover a nearly $800,000-a-year drug that Paxton Pope’s doctor believed could dramatically reduce his frequent seizures, his family initially braced for a serious medical setback.
Then the Popes learned about a little-known provision in the Affordable Care Act that allows asking an outside state-run panel to review the insurer’s decision — a move that led to the denial ultimately being overturned.
Experts say that while most patients don’t know these agencies exist, they can guide individuals or families through an additional step beyond the insurer’s internal appeals process: an external review.
“They’re a well-kept secret,” said Michele Johnson, executive director of the Tennessee Justice Center. “I think it’s definitely worth trying, and get doctors to help fight for you, because, of course, the doctor’s opinion is going to make a huge difference.”
Read more: nbcnews.app.link/wTmdnqW42Yb
