Insured to Death: How Health Insurance Screws Over Americans - And How We Take It Back

by Neal K. Shah, David Casarett (Foreword)

They're counting on your exhaustion, your confusion, and ultimately, your surrender.When UnitedHealthcare’s CEO was assassinated in December 2024, America was forced to confront an uncomfortable our healthcare system isn’t just broken. It’s breaking us.

Behind every denied claim is a family facing impossible choices. Behind every incomprehensible medical bill is a system engineered for profit, not healing. And behind the industry’s glossy commercials are executives earning millions while patients launch GoFundMe campaigns to stay alive.

This explosive exposé uncovers the trillion-dollar machinery of denial and delay that has turned the promise of health insurance into a nightmare for millions of Americans. Drawing from a wide range of sources - whistleblowers, patient stories, health policy data, and insider accounts - it compiles the full picture of a broken system. More importantly, it offers a battle-tested playbook for fighting back, and a bold proposal for how we can redesign health insurance to truly serve the people.

247 pages, Kindle Edition

Published June 27, 2025

About the author

Neal K. Shah is the Chief Executive Officer of CareYaya Health Technologies, a social enterprise and applied research lab advancing health equity for aging populations using artificial intelligence and neurotechnology and recognized by LinkedIn as one of America’s Top 50 Startups in 2024. He also serves as Chairman of Counterforce Health, an AI-driven platform that helps patients and providers navigate insurance claim denials. Shah is a Principal Investigator on multiple federally funded innovation grants, including one supported by the National Institutes of Health and the University of Pennsylvania to develop AI tools that assist patients in appealing denied health insurance claims. He also leads a separate NIH-funded collaboration with Johns Hopkins focused on improving dementia caregiving through AI tools that upskill and train caregivers.

Shah holds dual bachelor’s degrees in economics and philosophy, with a minor in mathematics, from the University of Pennsylvania. Before founding CareYaya, Shah managed a $250 million hedge fund. His pivot to healthcare came after deeply personal experiences as a caregiver, which inspired a mission-driven focus on transforming care delivery through technology.

Today, Shah is building strategic partnerships and technical capabilities to position CareYaya as America’s leading launchpad for care innovation, expanding access to affordable care, driving humanitarian progress, and fundamentally improving quality of life for vulnerable populations.

Shah’s work has been supported by the National Institutes of Health, Johns Hopkins AITC, and Harvard Innovation Labs. He is also a prominent thought leader in health innovation, with features and contributions in CNBC, The Wall Street Journal, Barron’s, STAT, Neurology Live, and TechCrunch.

Reviews

[Sophia Yacap]

5 stars

I really enjoyed reading this one , I would definitely recommend. This book was very informative and eye opening .

[Kelli Glazebrook · Rating 5 out of 5]

I’ll get banned if I say what I really think!

[Adnan Akanda · Rating 5 out of 5]

After my own nightmare battling insurance denials during chemotherapy, I wish I'd had this book. It masterfully combines heart-wrenching personal stories with practical guidance that actually works. His three-layer solution offers hope that we can fix this broken system. Every cancer patient and their families need these tools in their arsenal.

[Alex Joss · Rating 5 out of 5]

As a former claims adjuster, I can confirm every disturbing detail exposed about denial quotas and algorithmic rejections. This book courageously tells the truth about an industry that profits from human suffering. The proposed solutions are thoughtful and could actually work. I hope every American reads this.

[Felipe B. · Rating 5 out of 5]

I'm 28 and healthy, so I never thought much about health insurance until my appendix burst. The $47,000 bill opened my eyes to how broken our system is. This book explains exactly what went wrong and how to protect yourself. His writing is engaging and urgent - this isn't dry policy analysis but a call to action for my generation.

[Rebecca Parr · Rating 5 out of 5]

This is the ultimate guide to fighting health insurance denials that every American needs. Shah provides step-by-step strategies for appealing denied claims that actually work. I successfully overturned three major denials using his methods, saving my family over $15,000. If you're battling insurance companies, this book is your secret weapon for winning appeals and getting the coverage you deserve.

[Riyaa Jadhav · Rating 5 out of 5]

Huge thanks to the publisher for the early access to this powerful read. This book made me feel every emotion, anger, disbelief and most of all, urgency. It pulls back the curtain on how our health insurance system actually works (or doesn’t), and the result is nothing short of devastating. The data is damning, and the writing is sharp and clear without ever becoming overwhelming. What I loved most? It gives you a roadmap to fix it. It’s hopeful, actionable, and honestly left me fired up in the best way. Also, the comics were funny, painfully relatable, and the perfect visual punch to break up the intensity while still driving the point home. I found myself laughing out loud one moment, then fuming the next. I highly recommend you to add this to your TBR if you care about justice in healthcare. You won’t regret it.

[Abby Bloom · Rating 5 out of 5]

Insured to Death is a must read for all: all of us who have (and especially those who don’t have!); insurers (obviously); every employer offering paid health insurance for employees; health policy experts and scholars globally; and lawmakers. Effectively everyone. I am a global healthcare expert, and I’ve already bought 2 copies of Insured to Death, one for me and one for an elected official.

Shah lifts the lid on one of the main drivers of the failure of the US healthcare system. But he goes a lot further, giving people whose claims have been denied a step by step roadmap on how to get their claims paid, and the motivation to persist.

He then turns his attention to nothing less than a prescription and roadmap for fixing the ailing US healthcare system. You’re guaranteed to come away much the wiser. Cynical. But savvy.

[Andrew Sutherland · Rating 5 out of 5]

Finally, a book that explains how to navigate health insurance appeals without needing a law degree. The book’s appeal letter templates and documentation strategies are incredibly effective. Author’s insider knowledge of how insurance companies actually make decisions gives patients a huge advantage. Essential reading for anyone dealing with wrongful claim denials or fighting for medical coverage.

[Joshua Gill · Rating 5 out of 5]

This comprehensive guide to American healthcare reform offers the most realistic solution I've seen. Shah's three-layer approach combining universal catastrophic coverage, expanded health savings accounts, and direct primary care could actually work. Unlike other healthcare policy books, this one provides a pragmatic path forward that both parties could support. Brilliant healthcare reform analysis.

[Francisco V. · Rating 5 out of 5]

An eye-opening exposé of health insurance company tactics that will make you angry and then empower you to fight back. Author documents how major insurers like UnitedHealthcare, Cigna, and Aetna systematically deny valid claims to boost profits. His insider interviews with former insurance employees are particularly damning. Essential reading for understanding how health insurance really works in America.

[Jay E. · Rating 5 out of 5]

The definitive patient advocacy guide that teaches you how to appeal insurance denials like a pro. The author’s practical strategies for gathering medical evidence, writing effective appeal letters, and escalating to external review have helped thousands of families win their cases. His success rates are impressive - this isn't theoretical advice but proven methods that work against even the largest insurance companies.

[Niom · Rating 5 out of 5]

A powerful critique of for-profit health insurance that exposes how these companies prioritize shareholders over patients. The author documents the human cost of denial-driven business models while providing hope through proven reform strategies. His three-layer solution offers a realistic alternative to both pure market-based and single-payer approaches. Compelling reading for healthcare reform advocates.

[Mohad · Rating 5 out of 5]

This book reveals exactly how to fight medical billing errors and insurance claim denials effectively. Shah's step-by-step appeal process has helped me recover thousands in wrongfully denied benefits. His technology recommendations for price transparency and billing advocacy are game-changers. If you're tired of being taken advantage of by the healthcare system, this book shows you how to fight back.

[Moinal · Rating 5 out of 5]

The most comprehensive analysis of healthcare industry problems and solutions available today. The author expertly explains how insurance consolidation, hospital monopolies, and pharmaceutical pricing drive up costs while reducing quality. His proposed reforms combining market mechanisms with universal protection offer genuine hope for fixing American healthcare. Essential reading for anyone interested in healthcare policy.

[Binaga · Rating 5 out of 5]

This practical guide to medical debt relief and insurance appeals should be required reading for all patients. Author’s strategies for negotiating hospital bills, challenging wrongful denials, and accessing financial assistance programs are incredibly valuable. His understanding of both the system's failures and available patient protections is comprehensive. A lifeline for families struggling with healthcare costs.

[Eloise Todd · Rating 5 out of 5]

This powerful patient rights handbook teaches you everything you need to know about fighting insurance companies and winning. Author’s detailed explanations of appeals processes, external review options, and regulatory complaint procedures give patients the knowledge they need to hold insurers accountable. His success stories prove that determined patients can overcome even the most aggressive denial tactics.

[Kieran Herbert · Rating 5 out of 5]

An essential guide to healthcare advocacy that shows how individual action can drive systemic change. The author masterfully connects personal insurance struggles to broader reform movements, providing both immediate help for current problems and long-term strategies for transforming American healthcare. This book empowers readers to become effective advocates for themselves and their communities while working toward comprehensive reform.

[Jacob · Rating 4 out of 5]

A must-read for navigating today’s absurd health insurance terrain. It’s rough out there. There’s a lot of actionable insight in this book. The main critique I have is that I find the bigger-picture ideas the author discusses at the end of the book to be untenable. What I find most valuable here are the strategies for individuals to take back their own power for their own circumstances.

[Louis Rose · Rating 5 out of 5]

This book is a total game-changer. I've been getting the runaround from my insurance for months, but Shah's strategies actually work. Got my MRI approved in two weeks using his methods. The guy knows his stuff and explains it in a way that doesn't make your brain hurt.

[Sebastian Henry · Rating 5 out of 5]

Holy hell, the insurance industry is even worse than I thought. Shah pulls back the curtain on all their dirty tricks. But it's not just doom and gloom - he gives you actual weapons to fight back with. Already used his price comparison tips to save $300 on my medication.

[Adam Field · Rating 5 out of 5]

My sister recommended this after her own insurance battles. Glad she did! Shah's writing is engaging and he doesn't sugarcoat how broken everything is. The appeal letter templates are clutch. Finally feel like I have some power when dealing with these crooks.

[Steven Red · Rating 5 out of 5]

As an ER doctor, I see the devastating effects of insurance denials daily. Shah's book brilliantly exposes the systematic cruelty behind claim rejections while providing actionable strategies for fighting back. The chapter on physician handcuffs particularly resonated - I've lived through every scenario he describes. This should be required reading for every healthcare worker and patient in America.

[Emily Parker · Rating 5 out of 5]

Read this in one sitting because I couldn't put it down. Shah tells stories that will make you cry and strategies that will make you cheer. The three-layer solution actually sounds doable unlike most healthcare reform ideas. This guy should run for office.

[James Thompson · Rating 5 out of 5]

Picked this up at the airport and ended up canceling dinner plans to finish it. Shah nails exactly why healthcare is so expensive and frustrating. His tech recommendations are super helpful too - found apps I never knew existed. Worth reading even if you think you understand the system.

[Olivia Bennett · Rating 5 out of 5]

This book saved my sanity. Was about to give up fighting a huge medical bill until I read Shah's negotiation tactics. Cut my bill by 60%! The stories from insurance workers are crazy - they're just as trapped as we are. Eye-opening stuff.

[Michael Johnson · Rating 5 out of 5]

Finally someone who gets how messed up this whole system is. Shah doesn't just complain though, he gives you tools that actually work. Used his appeal process for my mom's denied treatment and we won. The man is a hero for writing this.

[Ava Mitchell · Rating 5 out of 5]

Started reading this because my friend wouldn't shut up about it. Now I'm the one recommending it to everyone. Shah's breakdown of insurance company tactics is mind-blowing. The direct care chapter especially opened my eyes to alternatives I didn't know existed.

[Ethan Carter · Rating 5 out of 5]

This book is both terrifying and empowering. Terrifying because of what Shah reveals about how insurance companies operate, empowering because he shows you how to beat them. Already planning to use his strategies for my upcoming surgery authorization. Wish every American would read this.

[Sophia Roberts · Rating 4 out of 5]

Best $20 I've spent in years. Shah's appeal strategies helped me overturn a $15,000 denial in three weeks. The book pays for itself immediately if you have any insurance issues. Plus it's actually entertaining to read, which is rare for healthcare books.