Coverage Denied: How Health Insurers Drive Inequality in the United States

by Miranda Yaver

In the aftermath of the assassination of United Healthcare CEO Brian Thompson in December 2024, everyday Americans took to social media to share stories of the challenges they'd faced trying to navigate the American health insurance system. Why did this event strike such a nerve with the American public? For a topic as central to the lives of Americans as healthcare, there is no book that examines the impact of coverage denial, whereby health insurers decide whether to cover health services that appear to be within the scope of a plan's benefits – not until now. In Coverage Denied, health policy professor Miranda Yaver offers a sobering account of the ways in which coverage denials damage patient health and exacerbate inequalities along income, education, and racial lines. Combining rich interview material with original survey data, Yaver draws critical attention to the tens of millions of medical claims denied by health insurers every year, shining a necessary light on our inequitable health care system.

Genres: Politics, Nonfiction

Unknown Binding

Reviews

[Annotations&Air · Rating 5 out of 5]

“They take in premiums and don’t pay claims. That’s how they make money.”

As of 2024, 65% of U.S. residents are enrolled in private health insurance plans. Roughly three billion (3,000,000,000) insurance claims filed by U.S. residents are denied each year. Approximately half of those claims are ultimately overturned on appeal—but not before a toll is exacted on patients, and often their families, in psychological and financial terms that can last years or even decades.

Coverage Denied is a long-overdue work of high scholarly and scientific merit that exposes, with mathematical precision, how the United States came to operate a healthcare system that places its greatest burdens on those who need it most. Columbia-educated professor Miranda Yaver draws on original survey data, interviews, and rigorous review of existing studies to demonstrate how discriminatory and exclusionary insurance practices disproportionately harm women, non-native English speakers, and people with chronic illness. She further shows how these practices exacerbate already sky-high per-capita medical spending without delivering commensurate health outcomes.

Yaver guides readers through the development of U.S. healthcare policy beginning in the 1930s, tracing the legislative and political forces that produced today’s privatized, corporatized, market-based system. She identifies administrative burden and inequity as the two central legacies of this paradigm—forces that continue to drive health disparities. Prior authorization emerges as the primary mechanism by which insurers deny care, one among many denial practices examined in this volume that impose costs on physicians, insurers, and patients alike. Prescription step therapy, care postponement, cost shifting, labyrinthine appeals processes, and the particular challenges of accessing behavioral health care are explored in successive chapters through data-driven analysis and interpretive commentary.

Importantly, Dr. Yaver does not leave readers mired in despair. She concludes with practical guidance for patients navigating communication with physicians and insurance companies, alongside policy-level recommendations aimed at industry reform and legislative action. The book’s publication is especially timely, with the 2026 election season approaching and healthcare reform once again prominent in public discourse.

This work will be invaluable to students of public health policy and legislation, as well as to physicians, reformers, and patients seeking a deeper understanding of this critical subject. The writing is scientific, clear, and direct. Some familiarity with statistics will be helpful when engaging with the data. Comprehensive appendices, tables, notes, and an index further enhance the book’s utility as both a scholarly and practical resource. Thank you to NetGalley, Cambridge University Press and the author for the advance copy in exchange for my honest review.

[Christopher Hagan · Rating 5 out of 5]

As someone who has delayed or ultimately cancelled scheduled care because of higher-than-expected costs, I find that Yaver does an excellent job exploring insurers' incentives and practices for increasing the healthcare burden. It isn't just that this book helps me explain my experience in the American healthcare system, it's that, having read this, I am more empowered to fight my way through the inevitable bureaucratic catastrophe that any health insurance claim may be.

Yaver's prose is excellent and, while it is published by an academic press, this book makes use of interviews to reinforce data in a relatable way. I have fought insurance companies for years to get basic health coverage, from physical injuries like concussions to genetic autoimmune disease and ongoing, unexplained issues. The stories from the interviewees are tangible. I can feel the words of the patients move me. Yaver uses the stories to illuminate the numbers, and having read the book I now feel comfortable communicating how my struggles relate to the political world we live in.

I pre-ordered and received this book ahead of its scheduled release, so I did begin reading ahead of the release date. I only read a little at a time because the stories carry weight and it takes some time to process the emotion and make the information digestible. This isn't a detriment to the book but rather a statement of the power of the stories. I have fought the healthcare system, largely unsuccessfully, for many years.

Through a long history of poor choices, we Americans have decided to live in a system that is more costly, denies more care, and is less efficient than most other developed countries. Any work explaining why we've ended up here and how we can change for the better is worth its weight in gold. Coverage Denied is the best of this bunch and should be a staple read for the healthcare industry.

[Chelsea Knowles · Rating 3 out of 5]

*Thanks to NetGalley and the publisher for an advance reader copy of this book in exchange for an honest review.*

Coverage denied looks at the American healthcare system, specifically the prior authorisation that a lot of insurance companies now use. The conversation around American healthcare was sparked by the assassination of UnitedHealthcare CEO Brian Thompson in December 2024. After the event, American citizens started to share their stories of accessing healthcare and this book showcases people’s stories. As the title suggests, this book explores the coverage denials that people have experienced mainly due to prior authorisation. This book uses interviews and surveys to evidence the points made. This book discusses the reasons for coverage denials, whose coverage gets denied, the cost to patients and who wins and loses appeals.

I think this is an important book and I like how this has interviews and surveys to evidence the points made. Personally, I really enjoyed reading the personal stories and understanding people’s perspectives of navigating American healthcare systems. I did have some issues with the way this book is written though as the author constantly repeats what will be written in the next chapter and then there is a conclusion section at the end of each chapter where information was repeated. This got on my nerves and made it difficult for me to get through this book. That said, I think this has some valuable information in it and this reveals how difficult it is for many people to access the care they need.

“Now I realize that insurance is great unless you need it. If you need it, you’re screwed because they don’t want to pay.”

[January Johnson · Rating 2 out of 5]

If you know nothing about health insurance companies make money and avoid paying for claims, this might be an eye-opening book.

If you know a little bit about that above topic, it will give you plenty of examples and some additional thoughts.

If you, like me, know quite a bit about it already, you may find (as I did) that it's highly repetitive, and never actually takes any solid positions on anything. The chapter on the way forward does not actually suggest any concrete ideas of how to improve things from here.

I feel like this was a masters thesis that got expanded into a book: well researched but far too many similar examples, and very little interpretation or stance taking.

It's kind of like: Health insurance is bad -- and fire is still hot.

I got in a long line of requests to get this book from my library, hoping to learn something new and significant, based on the hype surrounding the book. I didn't really.

I wish the author had taken the time to synthesize her narrow thesis into a more integrated viewpoint on how politics and capitalism work to create, further and perpetuate this atrocity being foisted on the American public. I wish the author had taken a strong stand, on something, anything.

[Jamie K · Rating 3 out of 5]

Important information, and obviously a labor of love in terms of research. I wish someone at the editing stage had pushed Yaver toward a different format/style, though -- this reads like a series of research papers, and I think that really hurts its readability for the average reader. I got through it and I'm glad I did, but it took me so much longer than it needed to because the style was just such a slog.

[Katie Badger · Rating 5 out of 5]

This book is an excellent crash course for understanding health insurance disparities in the American Healthcare System. This is such pertinent information for patients and practitioners alike. HIGHLY recommend if you interact with the AHS in any capacity!

[Ffiefvoley · Rating 5 out of 5]

Let's go!!! Tear it down and build something better.