Our nation and the health care industry have been in shock following the assassination of the CEO of one of the largest insurance companies in the U.S. in December 2024. The reaction to Brian Thompson’s death and suspected shooter Luigi Mangione appeared to have captured America’s attention. The assassination has focused public outrage toward the health care insurance industry and a lack of empathy for the victim and his family. A recent survey showed that 41 percent of those 18 to 29 years of age felt the killing was “acceptable.” It is no surprise that the stock price for UnitedHealthcare has taken a dive following the assassination.

There are many occasions when an insurance company places the doctor in the middle of a coverage issue between the patient and the insurance company. Insurance companies are motivated to keep down costs and often deny coverage for medications, services, treatments, or durable medical equipment (DME). At the present time, there is no evidence that the assassin was insured by UnitedHealthcare or was denied coverage for his medical problems.

While this recent event has polarized our nation, I want to share one of my successful experiences as an advocate for my patient.

Melissa’s story

Melissa, that’s her real name, and her name is used with her permission, was a quadriplegic patient from birth secondary to cerebral palsy. She could not use her voice and could only make unintelligible sounds understood only by her parents and close friends. She wanted to attend public high school but could not communicate with the teacher or her classmates. With public funds, she received a voice synthesizer (VS). The patient’s mouth controls the computer program. It allows users to select words that become audible and even digitalized to be used for homework and other assignments.

Melissa received the voice synthesizer, learned to use it well, and graduated with honors in her class. Melissa’s parents requested that she keep the VS program upon graduation so she might attend college. The school board met and denied the request by using the comparison that the VS was like a football helmet used by a player while on the team and that it was on loan and couldn’t be given to players upon graduation. The VS would not be used by any other student and would remain in the school’s closet, gather dust, and eventually be discarded. The school would not make an exception and grant her the use of the VS upon graduation.

Fighting the denial

I suggested that her family request a VS device from the family’s insurance company, which cost about $10,000. The medical director from the insurance company denied the request. I contacted the medical director to request an explanation. The medical director told me that this was a “creature comfort” and that the insurance company would not pay for the VS. I wrote a letter on behalf of Melissa to the medical director with a copy to Melissa’s father’s employer, UPS, requesting an appeal. I could not attend the hearing (this was long before Zoom meetings), but I was on the conference call with Melissa’s parents and the medical director of the insurance company.

The medical director of the insurance company explained that Melissa was born without a voice; therefore, it wasn’t the insurance company’s responsibility to provide her with a voice that she didn’t have at birth. They explained that replacing her voice was not part of their UPS contract. They offered the comparison that if Melissa was born without a leg, they wouldn’t be required to provide her with a prosthesis. However, a prosthesis would be provided if she lost the leg after birth.

This response infuriated both the parents and me. Her father was fearful of causing a problem with the employer. He was hesitant to pursue the matter and considered taking out a bank loan to buy Melissa a VS so she might attend college. With the family’s permission, I told them I would be their advocate and try to help Melissa get her voice back.

The power of advocacy

I first wrote a letter explaining the situation to the state insurance commissioner where Melissa lived. I sent a copy to the employer and to the medical director. I wrote a letter to the family’s U.S. Congressman and their U.S. Senators, asking for their intervention. I also wrote a letter to 60 Minutes telling them the story and offering to have Melissa and her family tell her story and give the name of the insurance company and the employer on national TV. A copy of this letter to 60 Minutes was sent to the insurance company’s medical director and the employer.

One of the senators sent a letter to the insurance commissioner of the state and to the medical director requesting a better explanation of the denial of the request for the VS. Within one week of the U.S. Senator receiving a letter, I received a letter from the medical director of the insurance company indicating that the insurance company authorized the VS!

Melissa received a new VS and was able to attend college. She is an author and working on a book about living with cerebral palsy, which includes a chapter on how she got her voice back.

A call for reform

Advocating for my patients successfully was one of the highlights of my medical career. There are so many instances when we receive a rejection from an insurance carrier that denies an appropriate treatment or a device that restores people to good health, keeps them out of the hospital and doctors’ offices, and even gives them their voices back.

Certainly, I cannot do this for every patient who has issues with insurance companies. Still, I can find the most egregious rejections and serve as an advocate for my patients. I can share with you that there is nothing in medicine that provides more pleasure and satisfaction than standing up for your patient when you know you are right and when your patient is made to suffer because the insurance company is focused on their bottom line and not on the patient’s health care and well-being.

I agree that the American health care system is ailing and needs a major surgical intervention to remove some of the pain points, including patients’ and physicians’ dissatisfaction with the insurance industry. My take-home message is that we don’t have to resort to violence to fix the system. We can move towards a more fair, efficient model that returns to focusing on the patient. The result will be that all Americans have access to high-quality, affordable health care.

Neil Baum is a urologist.