Heart Attack at 37. Then the Letter: "Not Medically Necessary."
She's 37. She had a heart attack two weeks ago. Now she has a letter from her insurance company to share.
In a video we stitched this week, she reads from it. According to the letter she shared, Cigna wrote that "after carefully reviewing the information," it determined "the service is not medically necessary." Her reaction: "So they don't think that saving my life was medically necessary."
She was remarkably calm about it. We weren't.
Two Days, a Cath Lab and $110,000
She says she spent two days in the hospital: the emergency room, the cath lab and everything in between. A cath lab, short for cardiac catheterization lab, is where cardiologists thread a thin tube into the arteries of the heart to find a blockage and open it.
Her total bill so far, she says, is $110,000. She expects more bills are still coming.
That's what it cost, in her words, "to save my life." The letter she got back used one phrase to describe the service: not medically necessary.
Who Decides What's Necessary
"Medically necessary" sounds like a medical judgment. On a letter like this one, it's a coverage decision made by the insurer.
The doctors in the ER and the cath lab made their calls in real time, with the patient in front of them and her heart on a monitor. Nobody in that room was waiting for permission. The letter came later, from a company that wasn't there.
That's the problem we called out in the video. This is what happens when we let administrative middlemen who aren't involved in the care be in charge of the care.
Denials Are Routine. Appeals Are Rare.
Her letter isn't a strange one-off. KFF analyzed federal data on HealthCare.gov marketplace plans and found insurers denied 19% of in-network claims in 2024, about 85 million claims. Out-of-network claims were denied at 37%.
The reasons are murky. In KFF's analysis, the most common denial reason was "other," a reason not listed, at 36%, followed by administrative reasons at 25%. Only 5% of in-network denial reasons cited medical necessity. Insurers don't report which services were denied, so nobody outside the company can see what's behind most of those letters.
People rarely fight back. KFF found fewer than 1% of denied in-network claims were appealed, and when people did appeal, insurers upheld their original decision 66% of the time. A January 2026 KFF poll found a third of insured adults say an insurer denied coverage for care or a medication their doctor prescribed in the past two years.
The Paperwork Lands on the Patient
A denial letter starts a process, and the patient is the one who has to run it.
HealthCare.gov explains that insurers have to tell you in writing why they denied a claim. You can file an internal appeal, asking the insurer to review its own decision, within 180 days of the denial notice. For services you already received, the insurer has up to 60 days to decide. If it still says no, you can ask for an external review by an independent third party.
That's months of forms, claim numbers, doctor's letters and phone calls, handed to someone who is two weeks out from a heart attack and still opening new bills.
You Already Paid for This
We send them all of our money. Premiums come out of paychecks before anyone sees a doctor. Employers pay their share out of the same budget that could have gone to raises.
Then we hope the company holding that money decides to spend it on us. The middleman takes a slice of every dollar that passes through, and it also gets to decide which care counts. The patient, the doctor and the employer paying the premium all wait on its answer.
It's bonkers.
Fire the Middlemen
Cut the waste. Fire the middlemen. That's what we did at Forest Park Pharmacy.
We don't take insurance. There's no claim to deny and no letter showing up later telling you whether your medication counted. Every drug is priced at actual acquisition cost plus a transparent fee, and you see the price before you pay. We have no reason to pretend the price is higher than it is. We compete on price.
Head to forestparkpharmacy.com to look at our price checker and transfer today to save. See ya.
