Insurers have a very strong incentive to not pay out claims, they want to hold on to as much of the premium as possible and want to direct as much of the premiums as they can into their related family of companies to continue to keep a high overall share of margin through vertical integration (page 8 on this FTC report gives a good visual overview). A recent KFF analysis based on 2023 data found, on average, insurers denied 1-in-5 claims.

Seeing that didn't surprise me, the number of reports on denial rates and lawsuits over excessive denials has been a consistently growing drum-beat with United, Cigna, and Humana all facing lawsuits recently over excessive denials with inadequate human review.

The statistic that concerns me even more though is that consumers appealed denials less than 1% of the time.…