Life Kit Podcast Summary

Episode: What to do when your health insurance denies coverage
Host: Marielle Segarra (NPR)
Guest: Jackie Fortier (KFF Health News)
Date: September 18, 2025

Overview

This episode of Life Kit is an essential guide to handling one of the most aggravating aspects of the American healthcare system: what to do when your health insurance denies coverage for preventive care services. Host Marielle Segarra, joined by healthcare journalist Jackie Fortier, breaks down how preventive services should be covered by law, why denials still occur, and—most importantly—how listeners can effectively appeal these decisions. The episode is filled with practical advice, step-by-step instructions, and empowering reminders that you have rights and options.

Key Discussion Points & Insights

1. Preventive Care—What’s Supposed to Be Free

[03:05]

• Definition: Preventive care includes annual physicals, vaccines (flu, shingles), cancer screenings (mammograms, colonoscopies), well-woman exams (breast and pelvic), and more.
• Who is covered: Most health plans must cover preventive care with no out-of-pocket costs under the Affordable Care Act, but eligibility depends on age, gender, and health history.

  “Under most circumstances, recommended preventive care is supposed to be covered at no out of pocket cost under the Affordable Care Act.” — Jackie Fortier [03:08]

2. Why Coverage Gets Denied

[03:30–05:44]

• Common reasons: Coding mistakes, classification errors during visits, or outright administrative errors.
• Diagnostic turns: If a wellness visit becomes focused on a specific health problem (e.g., discussing an unusual mole), that portion may not be coded as preventive—and may result in a bill.

  “If a health issue comes up...that consult can be billed separately. So the patient could then owe like, a copayment or a deductible charge for that part of the visit.” — Jackie Fortier [04:41]

3. When You Receive a Bill—First Steps

[05:31–06:43]

• Check for errors: Confirm that the provider submitted the claim to your insurance. Sometimes, bills are sent before even doing so, or are sent to the wrong insurer.

  “The provider may not have submitted the claim to insurance or you get a rejection from insurance, but a rejection in that case...is often something you can appeal and win.” — Jackie Fortier [05:44]

• Don’t pay immediately: Even if a bill says “due upon receipt,” take the time to investigate.

4. Appealing a Denial—How To Do It

[07:02–12:08]

• Emphasize persistence: Insurance companies “count on people giving up,” but most appeals succeed.

  “Do not take the first no as the final answer. It’s really just a starting point.” — Jackie Fortier [07:02]

• Step-by-step appeal:
  1. Read the denial document for the actual reason.
  2. Contact customer service—be polite and record who you speak to and what they say.
  3. Gather key documents: Explanation of Benefits, insurance policy, medical records, doctor’s letters, and, crucially, documentation showing that the service should be federally covered as preventive.
  4. Write an appeal letter: Keep it factual and concise—emotional appeals aren’t effective.
  5. Submit correctly: Use the portal or certified mail, keep all records, and confirm receipt.
  6. Notify the provider: Inform the hospital/doctor billing office that you’re actively disputing.

  “Appeals are not about emotion. They’re about documentation.” — Jackie Fortier [12:08] “Don’t put the bill on a credit card, because then it changes it into credit card debt, and you lose a bunch of protections.” — Jackie Fortier [10:06]

5. If Your Appeal Is Denied—Next Steps

[15:20–18:11]

• External medical review: Legally required, unbiased review by a third-party health professional. Their decision is final and binding.

  “This is like the Supreme Court of Health decisions. Their decision is final...But it’s unbiased, it’s medically based, and it is legally binding for your insurance company.” — Jackie Fortier [15:51]

• How to request: Instructions buried in denial documents; state insurance departments or nonprofits can help.
• Odds of success: “72% of [California] health fund members...end up getting the service that they requested.” — Mary Watanabe, via Marielle Segarra [17:20]

6. If All Else Fails—Negotiation & Assistance

[18:34–21:42]

• Financial assistance: Nonprofit hospitals must offer it; you may qualify even if underinsured.
• Negotiate bills: Ask for discounts (“settlement amount”) or payment plans (with no interest or late fees).

  “Han[e]s said they just want to get paid. You know, if you offer cash, sometimes there’s a discount.” — Jackie Fortier [19:54]

• Employer assistance: HR might step in, especially if it’s a recurring issue. Sometimes, they’ll reimburse you or advocate for coverage changes in future plan years.

Notable Quotes & Memorable Moments

• Validating Frustration:

  “Rage because now I have homework to do... Rage because why is our health care system like this?... If you feel rage or frustration or exhaustion or any of the above...that is understandable.” — Marielle Segarra [00:21]

• Real-world Struggles:

  “I talked to Anna Deutscher, whose baby son needs hearing tests...her insurance wouldn’t cover. She would spend her lunch breaks on the phone... It feels like the burden goes on the person who’s just trying to get health care. I don’t need to also make sure that the hospital codes it correctly.” — Jackie Fortier [07:02]

• On Writing the Appeal:

  “Keep it short, sweet, and factual.” — Jackie Fortier [12:17]

• External Review Success Rates:

  “72% of health fund members that come to us and file an independent medical review end up getting the service that they requested. Those are good odds.” — Mary Watanabe (quoted by Marielle Segarra) [17:20]

Timestamps of Important Segments

• What counts as preventive care: [03:30]
• Why preventive care gets billed: [04:32–05:44]
• How to approach a denial: [07:02–09:47]
• How to file an appeal step-by-step: [10:48–12:31]
• What to do if your appeal is denied: [15:20]
• External medical review process and odds: [16:03–17:35]
• Negotiating bills & financial assistance: [18:34–21:42]
• Employer/HR's role: [20:17–21:42]
• Five key takeaways recap: [22:10–24:36]

Recap — Five Practical Takeaways

[22:10–24:36]

1. Know your rights: Federal law mandates many preventive services be covered at no cost.
2. Double check billing mistakes: Many denials are simply errors—verify and appeal.
3. Use the appeal process: Compile documents, file a factual appeal, notify providers, and don’t pay immediately.
4. Go external if you lose an appeal: Request a third-party review; most succeed.
5. Seek help if you still owe: Look for financial assistance, negotiate, avoid credit cards for medical debt, and reach out to your employer’s HR.

Tone: Supportive, practical, validating the frustration many listeners feel while encouraging them to persist and equipping them with concrete steps.

Best For: Anyone who has faced a health insurance denial, is anxious about handling medical bills, or wants to understand their patient rights under current U.S. health law related to preventive care.

“Do not give up.” — Jackie Fortier [15:26]