FOR IMMEDIATE RELEASE: Monday, October 20, 2025
CONTACT: Unai Montes, press@peoplesaction.org, 202-660-0605 (bilingual)
Analysis Paints a Picture of a Corporate Business Model that Limits Access to Health Care to Maximize Profits While Sidestepping State Regulators
Washington, D.C. – A new health data analysis report from People’s Action Institute reveals that the severity of the health insurance coverage denial crisis is worse than previously imagined. Despite the State of New York’s successful implementation of state standards beyond federal mandated consumer protections, data suggests private health insurance companies may be systematically denying, delaying, and forcing policyholders to pay out of pocket to minimize what they spend on care and maximize profit.
This report, Denied: The Harmful Role of Prior Authorization and Claim Denials in New York Health Insurance, found that financial considerations may be inappropriately influencing what should be decisions based on medical necessity. Additionally, under a corporate insurance model, a patient’s ability to access care is often reliant on their knowledge of and ability to utilize an incredibly convoluted and time consuming appeals process.
- External appeals are overturned in Managed Long Term Care and the Children’s Health Insurance Program insurance markets at rates of 72.12% and 59.84%, respectively.
- Claims are denied at a rate of at least 20% across market segments – amounting to over 59 million denials in New York each year, totaling over $89 billion in billed charges – but denial rates for some diagnoses, such as autism, substance use disorder, and cancer are disproportionately higher.
- Billed values for overturned internal appeals are higher than for upheld appeals – indicating that companies deny high-cost claims more aggressively instead of applying claim review processes consistently and fairly across claims.
Click here for the Executive Summary
Click here to download the full report
“The more care you need, the less likely you are to get it. Many believe that private insurance companies deny the care that health providers deem medically necessary, either arbitrarily, or flatly across all policyholders, regardless of medical need. Our analysis of coverage denials in New York suggests this may be true. Private insurers are systematically refusing to pay for some of the most expensive care needed by some of the most vulnerable populations,” said People’s Action Institute Health Care Campaign Director, Aija Nemer-Aanerud.
“We do not have a health care system. We have a predatory system that maximizes corporate profit through a cruel and perverse business model that places patients in harm’s way to protect bottom lines,” added Nemer-Aanerud.
“When it comes to getting the care we need, we don’t get a say. Our therapists don’t get a say. Our doctors don’t get a say. Billionaires and corporate CEOs get the first and last word. Private insurance companies put profits above people because they have been supported in doing so by corrupt federal politicians. If there is a stranglehold on access to care, an impossible labyrinth to appeal denials, and a policy of extorting out-of-pocket payments from policyholders in New York – a state with robust regulations and extensive, transparent, publicly available data about claims denials – then we can infer how bad things are in places that do not protect people and do not share data,” said People’s Action Institute Executive Director Sulma Arias.
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About People’s Action Institute:
For over five decades, People’s Action Institute and our affiliates have fought for reforms that recognize poor and working people’s dignity and make material and political improvements to millions of lives. Our victories include the Community Reinvestment Act, Superfund, the Affordable Care Act, the Dodd-Frank Financial Reform Act and the MAT Act.
We engage in issue campaigns, public education and training to advance a long-term agenda for racial, economic and gender justice. Our focus now is on deepening community organizing so we can build lasting power across the country.
About Care Over Cost:
Care Over Cost is a national grassroots campaign founded by People’s Action Institute and supported by 25 state and national organizations working to address the problem of health insurers stopping people from getting the treatment they need or refusing to pay for treatments people have already received.