Sheer Health Company Assists Patients with Insurance Claim Denials

A survey indicates that 73 percent of Americans consider delays and denials of medical treatment by health insurance companies to be a major problem. Sheer Health, a company founded to address these issues, assists clients in appealing insurance decisions. Co-founders reported that 20 percent of insurance claims are denied.

Mathew Evins, a marketing executive, experienced chronic back pain for eight years. By 2024, his condition made walking difficult, and his doctors recommended surgery after non-invasive treatments failed. His insurance company required additional physical therapy and denied coverage multiple times over seven months, leading to deterioration in his condition.

Evins described the process as emotionally challenging and physically painful. Doctors warned that delaying surgery could cause permanent damage. He noted that 27 million Americans lack health insurance, but his experience highlighted issues even for those who are insured.

Health's Services Patients can take a picture of their bill and upload it to Sheer Health.

The company then handles all aspects of appealing denials to the insurance provider. Services are available for $40 per month or a percentage of recovered funds if the appeal succeeds. A co-founder stated that the goal is for people to never have to deal with their health insurance again.

This resulted in approval, and Evins underwent surgery in mid-October 2024.

Hempstead, senior policy officer at the Robert Wood Johnson Foundation in Princeton, New Jersey, discussed common experiences with denials.

She cited an example of a patient denied coverage for Botox treatments for migraines after previously benefiting from them. Hempstead authored the book 'Uncovered: The Story of Insurance in America,' published by Oxford University Press. Hempstead stated that providers aim to deliver treatments they deem helpful, while insurers act as intermediaries in coverage decisions.

She noted that the need for services like Sheer Health indicates broader challenges in the health care system. Evins emphasized that insurance companies should have a voice in coverage, but they shouldn't have the definitive voice.

AHIP stated that health plans, providers, and drugmakers share responsibility for making high-quality care affordable and easier to navigate. Following approval, Evins reported improved health after his surgery.