How One Family Took on Their Health Insurance Company and Won

By Consumers for Quality Care, on March 1, 2023

A family is calling for change after shining a light on predatory health insurance billing practices, according to ProPublica.

Penn State University student Christopher McNaughton and his parents, David McNaughton and Janice Light, navigated the difficult and complex health insurance denial and appeal process for years to ensure Christopher was able to receive the life-saving treatment he needed to treat his ulcerative colitis, a chronic, inflammatory bowel disease that causes severe arthritis, diarrhea, fatigue, and life-threatening blood clots.

Before attending Penn State, a specialist at the Mayo Clinic was able to keep Christopher’s symptoms in check through a combination of costly medication. Once in college, Christopher got a new health insurance provider, one contracted by the University. This provider flagged his case as a “high dollar amount,” deemed the unconventional drug cocktail he was using as “not medically necessary,” and refused to cover the cost of his medication any further. Because of this, the McNaughton’s were forced to sue their son’s health care provider, who went to great lengths to avoid covering Christopher’s medication. The insurance provider went so far as to fabricate a statement from the doctor who prescribed Christopher’s treatment.

The pain the McNaughton’s went through with taking on their insurance company is not uncommon. About 1 in 7 health insurance claims are rejected, and according to a recent Kaiser Family Foundation study, consumers file appeals on only 0.1 percent of all denied claims. 

Christopher and his family had enough to worry about – fighting an insurance company to reverse a coverage denial should not have added to those worries. CQC urges lawmakers and regulators to hold insurers accountable for unfair denials.