The Journal: A Life-or-Death Insurance Denial
Hosted by Ryan Knutson and Jessica Mendoza | Released May 14, 2025
Introduction
In this poignant episode of The Journal, hosted by The Wall Street Journal and Gimlet, Jessica Mendoza explores the harrowing journey of Ed Stratton, a 65-year-old from St. Louis, Missouri, whose life hung in the balance due to an insurance denial for a crucial liver transplant. Through intimate interviews and detailed storytelling, the episode delves into the complexities of the U.S. health insurance system and its profound impact on individual lives.
Meet Ed Stratton and His Health Struggles
[00:05] Jessica Mendoza introduces Ed Stratton through his daughter, Erin Stratton:
“He has always had the biggest personality. He's really funny, very engaging.” —Erin Stratton [00:19]
Ed's vibrant life in St. Louis was dramatically interrupted in late 2023 when he began suffering from worsening health issues. Despite a history of enjoying activities like golf and maintaining an active lifestyle, Ed's condition deteriorated due to liver failure.
[00:43] Jessica Mendoza describes Ed's declining health:
“He would just get so sick. He was in and out of the hospital. He was really losing a ton of weight. He was very tired, couldn't eat.” —Erin Stratton [01:00]
The Quest for a Liver Transplant
As Ed's liver condition worsened, his doctors identified a liver transplant as the best possible treatment. However, securing approval from his insurance provider, Anthem Blue Cross and Blue Shield, proved to be a significant obstacle.
[01:35] Jessica Mendoza outlines the insurance hurdle:
“His doctors said the best solution would be a liver transplant. But there was a big hurdle Ed needed to clear. Getting approval from his insurance company, Anthem, Blue Cross and Blue Shield. But Anthem rejected his claim.” —Narration [01:15]
Erin recalls the emotional moment they received the denial:
“We get this denial letter at 4pm oh, man. I just remember the day. It was my mom's birthday, my mom's 65th birthday.” —Erin Stratton [01:53]
Understanding Insurance Denials
The episode sheds light on the prevalence and implications of insurance claim denials in the U.S. healthcare system.
[02:13] Jessica Mendoza explains the process:
“Say you get sick and go to the doctor... If insurance denies the claim, then it's up to you, the patient, to pay for it.”
[04:22] Julie Wernau, a colleague covering healthcare, explains insurers' rationale:
“What insurers say is it's their job to try to rein in the costs of our very expensive healthcare system and sort of toe the line of science and research.” —Julie Wernau [04:22]
Erin emphasizes the personal toll of such denials:
“He responded very well to chemotherapy. He was relatively, I'll say, healthy or feeling well the majority of the time...” —Erin Stratton [05:07]
Ed's Medical Battle and Insurance Rejection
Ed's battle began in 2019 with a colorectal cancer diagnosis, treated successfully with surgery and chemotherapy. However, by late 2023, his cancer had metastasized to his liver, leading to severe health complications.
[05:31] Erin Stratton details Ed's deteriorating condition:
“He was very tired. He would get the chills a lot, get a lot of fevers, and his bile ducts were narrowing because of the scar tissue...” —Erin Stratton [05:31]
Despite intensive medical efforts, Ed's prognosis remained grim, prompting his doctors to advocate for a liver transplant. Anthem's initial denial, citing the procedure as "investigational and not medically necessary," placed Ed's life in jeopardy.
Navigating the Appeals Process
Facing the denial, Ed's medical team embarked on a rigorous appeals process to overturn Anthem's decision. This involved submitting additional medical evidence and engaging with higher-level reviewers within the insurance company.
[06:39] Julie Wernau explains who reviews claims:
“These insurance companies have staff that are actually clinicians... their only job is to really, like, say, does this jibe with our policy?” —Julie Wernau [06:39]
Despite multiple appeals, including a third-party review, Anthem upheld its rejection.
[09:15] Julie Wernau outlines the appeals hierarchy:
“A lot of times that might involve some studies showing that the treatment is warranted... It’s almost like a court case.” —Julie Wernau [09:15]
Erin's Relentless Fight
Undeterred by repeated denials, Erin Stratton took proactive steps to challenge Anthem's decision. Leveraging her professional network and reaching out to nonprofits and healthcare agencies, she partnered with Waris Bokari, founder of the startup Claimable, to publicize her father's plight.
[14:24] Erin Stratton shares her dedication:
“I would start working on it at night... I was still working. Uh, I would say 100 hours, maybe.” —Erin Stratton [14:24]
Together, they crafted a comprehensive 60-page public appeal, outlining Ed's medical history and supporting research, and disseminated it to Anthem's CEO, media outlets, and government officials.
A Triumphant Resolution
After persistent efforts and widespread attention, Anthem reversed its decision in mid-July 2024, approving coverage for Ed's liver transplant.
[15:56] Ed Stratton expresses his gratitude:
“I feel good, Very good... three months from the time I had my surgery, I played my first 18 holes of golf, and now I'm back pretty much to normal.” —Ed Stratton [16:05]
Erin highlights the critical role her efforts played:
“I mean, I can’t tell you how determined she was and what she did on this thing. I mean, it was really impressive.” —Erin Stratton [16:37]
Broader Implications on Health Insurance
The Stratton family's story underscores systemic issues within the U.S. health insurance framework, where life-and-death decisions are often influenced by cost-cutting measures rather than patient well-being.
[17:09] Julie Wernau reflects on the situation:
“This is literally life and death. How could it just be about money?” —Julie Wernau [17:39]
Jessica Mendoza notes that only about 1% of people appeal insurance decisions, highlighting the daunting nature of such battles.
[18:19] Julie Wernau explains why appeals are rare:
“Most people get overwhelmed before they start when things seem impossible... so that's why.” —Julie Wernau [18:19]
Conclusion
Ed Stratton's journey from despair to recovery illustrates both the systemic challenges and the profound personal resilience required to navigate the U.S. health insurance landscape. While his story ended positively, it serves as a compelling call to reevaluate how life-saving treatments are accessed and funded.
[17:39] Julie Wernau concludes:
“The whole world of insurance is sort of making decisions around what should and shouldn't get paid for. In the case of various kinds of disasters... But in the Stratton's case, they were able to get insurance to pay for the liver transplant eventually.” —Julie Wernau [17:39]
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