Insurers do not deny care

I recently read this article about a physician's husband who died of suicide after being denied care in what's described as a resort-grade facility.

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My husbands suicide shows theres something very wrong with US insurance industry

Jimmc414•2026-07-20•154 points•164 comments

A thing that is done in the article that is commonly done in articles about US health care is that it describes insurance companies "denying care".

But six days into Randy’s eight-week hospital stay, our health insurance company denied any further inpatient care.

— Joy Evers, My husband’s suicide...

Despite what people claim, insurance companies do not actually stop providers from providing healthcare. What actually does happen is that providers deny care if they are not paid - either by you or by the insurance company. Some percentage of claims denied are incorrectly denied, and that is a problem, but the thing denied there is a claim or a request for prior authorization.

We wouldn't say a mortgage company denied you your home, or a student loan company denied you your education, or a home insurance company denied you a kitchen. In the case of denial, you have lost a mortgage, a loan, and a reimbursement respectively. Likewise, insurance companies don't deny you care, providers do.

This particular style of pedantry is important for a straightforward reason: one is not constrained to receive care through an insurance company. Misinforming people that insurance companies can deny care makes them abandon life-saving care. They have options:

• paying cash out of pocket
• paying on credit
• or just incurring bills that they can later pay.

In the tragic story that I read, the wife was a physician and therefore likely well-paid and yet the family decided not to pay for what their provider was telling them was life-saving care.

By comparison, when I was in the ICU it seemed natural to consent to treatment requirements that I would pay if my insurer didn't. Should I have decided not to get treated because the hospital wasn't in-network? Should I have refused to sign that I was responsible? I don't think so. I think overall the approach that I took of choosing to get treated and accept the financial risk was the right decision given that the condition I was experiencing was temporary and treatment would restore me to the functionality required to pay for it. If I had believed that only the insurer could make that decision, I would have foolishly chosen to not have internal fixation for my thumb and would have a limited ability to use my left hand. Because I knew that care could only be provided or denied by the provider, I chose to accept the liability.

In the absence of a health insurance system, it would not be the case that everyone would receive care. Our resources are still limited. Treatment would still be rationed, but just like San Francisco's building planning and permitting system requires one to hire expediters who know the right people and the right palms to grease, we would move from a legible structure where payment gates care to an invisible one where access gates care.

Using precise terms allows people to make the right decisions and allows us to model the world accurately enough that we can create changes with few unintended consequences. And it's hurting people who don't know better and take imprecise terms at face value.