1 in 5 Health Insurance Claims Are Denied — Here's How to Fight Back (As Seen on CBS Sunday Morning)

Mathew Evins spent years living with severe back pain. His doctors agreed surgery was necessary. His insurance company didn't. For seven months, he was stuck in appeals while his condition worsened.

Then he turned to Sheer Health.

We helped Mathew navigate the appeals process, gather the right documentation, and push back against his insurer’s decision. His case—like so many others—wasn’t about eligibility. It was about persistence, process, and knowing how to challenge a denial effectively.

His story was recently featured on CBS Sunday Morning, where Sheer Health was highlighted for helping patients fight health insurance claim denials and access the care they need.

But at its core, this story isn’t about a media feature.
It’s about what happens when someone needs care—and can’t get it.

When “No” Gets in the Way of Care

Before finding Sheer, Mathew did everything right:

• Completed additional physical therapy
• Worked closely with his care team
• Submitted the required documentation

And was still denied coverage—multiple times.
This is the reality for millions of people. When you're in pain, recovering, or trying to manage a condition, you're also expected to:

• Interpret complex insurance policies
• Track claims and prior authorizations
• File appeals within strict deadlines
• Advocate for yourself at every step

For most people, that’s overwhelming. And too often, denials go unchallenged. That’s where Sheer Health steps in.

We Do The Work—So You Can Get Better

CBS Sunday Morning featured Sheer Health as a solution built with a simple mission: patients shouldn’t have to fight their insurance company to get care. We handle that for them.
Sheer Health works directly with patients to take on the appeals process—from reviewing denial letters to building and submitting strong cases backed by clinical evidence.

With Sheer Health:

• Members upload a bill, claim, or question
• We review their insurance, benefits, and coverage
• We take over—from submissions and prior authorizations to disputes and appeals

“Our goal is for people to never have to deal with their health insurance again.”
— Ben Howard, COO

For Mathew, that meant getting his surgery approved—and finally finding relief. For all our members, it means less time on the phone, fewer delays, and a clear path to care.

👉 Watch the full segment: https://www.cbsnews.com/news/fighting-health-care-insurance-claim-rejections/

Why 1 in 5 Claims Get Denied (And What You Can Do About It)

Health insurance is meant to provide reliable access to care. But too often, it creates barriers instead.

According to the CBS report:

• 1 in 5 health insurance claims are denied
• 73% of Americans say delays and denials are a major problem

The surprising part? Many of these denials are reversible.

In many cases, it’s not about whether care is covered—it’s about how difficult it is to navigate the system, submit the right information, and communicate effectively with insurers.

That means patients are often left stuck—not because they don’t qualify for care, but because the process to access it is so complex.

How to Appeal A Denied Health Insurance Claim

If your claim is denied, you have the right to appeal—and the outcome can change if you follow the right steps:

1. Review your Explanation of Benefits (EOB)
2. Request the denial reason in writing
3. Gather supporting documentation
4. Submit a formal appeal
5. Request an external review if needed

Most people don’t realize there are multiple levels of appeal—or how often they succeed. But doing this while managing your health is a heavy lift. That’s why many patients choose not to do it alone and sign up for Sheer Health.

Why This Moment Matters

Being featured on CBS Sunday Morning signals something bigger: this isn’t a niche issue anymore.

Health insurance friction affects:

• Patients trying to access care
• Families & caretakers managing medical bills
• Employers supporting their employees health benefits
• Providers trying to deliver necessary treatments

The conversation is growing—and so is the need for solutions that actually work for patients, providers, and employers too.

A Better Way to Navigate Health Insurance

At Sheer Health, we know that health insurance should work for patients — not against them.

We’re building a system where:

• Claims are handled seamlessly
• Appeals are managed by experts
• Patients have full transparency
• Care isn’t delayed because of confusion

Until then, we’ll keep doing the work behind the scenes—so our members can focus on what matters most: getting better.

FAQ

What is a health insurance claim denial?

A health insurance claim denial occurs when an insurance company refuses to pay for a medical service, treatment, or prescription. This can happen for reasons like lack of prior authorization, deemed lack of medical necessity, or administrative errors.

How common are insurance claim denials?

Very common. Studies and reporting (including CBS Sunday Morning) show that about 20% of claims — 1 in 5 — are denied.

How many are recoverable?

A significant portion of denials are caused by administrative errors rather than a true lack of coverage. These are highly recoverable if handled correctly. Common "fixable" triggers include:

• Coding Errors: Incorrect CPT (procedure) or Dx (diagnosis) codes.
• Missing Info: Claims filed without necessary medical notes or member details.
• Provider Oversights: Out-of-network providers often bill without researching your specific coverage first.

Can denied claims be appealed?

Yes. Patients have the right to appeal denied claims, often through multiple levels (internal and external review). However, the process can be complex and time-sensitive.

Why is the appeal process so difficult?

While you have the right to appeal, the process is notoriously complex and time-sensitive because:

• Hard Deadlines: Most plans give you a strict 180-day window to file; miss it, and you lose the right to challenge the denial.
• Specific Evidence: You must prove "medical necessity" using the insurer’s exact criteria, which often requires deep research into plan documents.
• Administrative Maze: Navigating multiple levels of review (internal and external) requires precise paperwork that most out-of-network providers don't have the time to manage.

How does Sheer Health work?

Sheer Health helps you navigate health insurance with expert guidance and support. Standard members can get help understanding benefits, bills, and coverage. Premium and Max members also receive hands-on support with out-of-network claims, including submissions, follow-ups, reimbursements, and appeals.

What is an Explanation of Benefits (EOB)?

An Explanation of Benefits (EOB) is a statement from your insurance company that explains:

• What was billed
• What the insurance covered
• What you may owe
• It’s not a bill, but it’s essential for understanding how your claim was processed.

What is the difference between an in-network and out-of-network claim?

• In-network providers have negotiated rates with your insurer, resulting in lower costs
• Out-of-network providers can lead to higher out-of-pocket expenses or denied claims

Some claims are denied simply because the provider isn’t in your plan’s network.

What is prior authorization and why does it matter?

Prior authorization is when your insurance company requires your physician to submit documentation and receive approval before you can get a treatment, test, or medication.

Sheer Health helps you identify whether prior authorization is needed ahead of time—so you can avoid delays in care and unexpected out-of-pocket costs.

How long does a health insurance appeal take?

Appeal timelines vary, but generally appeals can take 30-60 days.
External reviews are more complicated, and can take additional time on top of the 30-60 days.

Delays during the process are one of the biggest barriers to timely care.

How much does Sheer Health cost?

Sheer offers three flexible membership options designed to match how often you need support and how complex your care is.

Our Standard membership is free, and you can sign up without a credit card. It includes access to core features like benefits and coverage questions, medical bill review, and help understanding EOBs and insurance terminology. Out-of-network claim submission and management are not included in this plan.

The Premium membership is $60/month. Premium includes everything in Standard, plus hands-on support for out-of-network claims — including submission, follow-ups, reimbursement support, and appeals when needed.

Sheer Health’s Max membership is $95/month. This plan includes everything in Premium, plus advanced support for more complex insurance needs like secondary coverage coordination, FSA/HSA guidance, third-party benefits navigation, and fertility-related insurance support.

Learn more about our membership tiers here.

Why is Sheer Health worth having?

Health insurance is complicated and rarely works in your favor without a fight. That's why we built Sheer Health to handle it on your behalf by challenging denied claims, correcting billing mistakes, and making sure you access every benefit you're entitled to. Because most people don't have the time or expertise to take this on alone.

On average, members save 3+ hours per claim and avoid unnecessary costs by identifying billing errors, appealing wrongful denials, and optimizing insurance benefits.

To date, Sheer Health has helped over 30,000 members and corrected millions of dollars in healthcare costs.
Because health insurance billing and claims are frequently complex and error-prone—1 in 5 claims are denied, and many of those denials are reversible—most members see value not just in cost savings, but in having a dedicated team proactively managing issues that would otherwise go unresolved.
In short, Sheer Health is built for anyone who wants to make sure they’re not overpaying for care or leaving benefits unused—without spending hours dealing with insurance companies themselves.