Mathew Evins spent eight years living with excruciating chronic back pain. By 2024, the marketing executive could barely walk. His doctors unanimously agreed: he needed surgery. His insurance company disagreed—repeatedly.
"They went back to my surgeon and said, 'Your patient needs another six weeks of physical therapy,'" Evins recalled. He complied. Then came another denial. And another. Seven months of delays followed, during which his condition deteriorated.
"Everybody I saw said, 'This damage could become worse and/or permanent, if the surgery isn't done as soon as possible,'" Evins said. "Emotionally, it's like a roller coaster. Physically, I just wanted relief."
Evins isn't alone. According to industry figures, roughly 20 percent of all insurance claims—one out of every five—are denied. A striking 73 percent of Americans now view healthcare delays and denials as a major problem, even as 27 million Americans remain uninsured entirely.
The System's Hidden Cost
Katherine Hempstead, senior policy officer at the Robert Wood Johnson Foundation in Princeton, New Jersey, has tracked this trend closely. She notes that patients increasingly feel caught between providers trying to help them and insurance companies blocking those efforts.
"It's not the case that the providers are the angels and the insurance companies are the devils," Hempstead explained. "But consumers feel like, 'Hey, doctors are actually doing something. They're trying to do something that they say will help me. And here is this intermediary coming in and saying that they can't do it.'"
She points to recurring patterns: denials for Botox treatments for migraines, unexplained delays in surgical authorizations, and appeals processes so labyrinthine that patients give up in frustration.
A New Solution Emerges
Enter Sheer Health, a company co-founded by Jeff Witten and Ben Howard specifically to fight insurance companies on patients' behalf. The premise is simple but powerful: upload your bill, and let Sheer handle everything.
"Our goal is for people to never have to deal with their health insurance again," Howard said. The company operates on two models—either a flat $40 monthly fee or a percentage of any money recovered.
For Evins, the impact was transformative. Sheer Health reviewed every detail of his policy, submitted an expedited appeal, and worked directly with his surgeon to resolve the authorization issue. "Sheer got everything resolved," Evins said. "And I finally had my surgery in mid-October."
A Symptom, Not a Cure
When reached for comment, the American Health Insurance Plans (AHIP) trade organization stated: "Health plans, providers and drugmakers share a responsibility to make high-quality care affordable and easier to navigate."
Yet Hempstead sees Sheer Health's success as revealing something darker about the system itself. "I think it's sad that we need that," she said. "It's treating a symptom, you know, which is often a good business idea, but it doesn't make me feel like, 'Okay, that's all we needed.'"
The emergence of claims advocacy companies underscores a fundamental breakdown in how Americans access healthcare. When patients need to hire intermediaries just to fight for coverage their doctors recommend, it suggests the system itself requires serious reform—not just workarounds.
This article is based on reporting by CBS News.