By Reid Zeising, Co-founder of GAIN Servicing
One in five in-network claims submitted to insurers offering plans through HealthCare.gov was denied in 2024. Fewer than 1% of those denials were ever appealed.
I understand why. I became one of those statistics myself.
What Happened to My Son
My son is a healthy teenage athlete. One day, out of nowhere, he blacked out and fell face-first, 6’1 and 205 pounds, straight to the ground. He broke his front teeth. He was unconscious. His mother and a friend were nearby but neither of them could physically move him. So they did the only thing anyone could do. They called 911.
An ambulance took him to the hospital. He was treated, he recovered and his teeth were fixed. He is fine now.
Then the bill came. AMR billed $2,746.08 for the ambulance ride. UnitedHealthcare paid $946.55. We were left owing $1,799.53.
I called and explained that this was a life-threatening emergency. The representative told me the claim would be resubmitted and that I shouldn’t worry about it. Months later, a letter arrived saying the appeal had been denied. When I called again, I was told that $946.55 was the contracted amount and that AMR was considered out-of-network.
That is exactly the problem.
Nobody Checks Network Status During an Emergency
When your child is unconscious on the ground, you are not pulling up a provider directory to check whether the ambulance being dispatched is in network. You are not calling your insurer to ask what your reimbursement rate will be. Those decisions get made in seconds, by 911 dispatchers, not by patients or their families, and certainly not with a spreadsheet of network agreements in hand.
Ground ambulances remain one of the biggest gaps in the No Surprises Act, the federal law that was supposed to end this exact kind of billing shock. Emergency room visits are protected. Air ambulances are protected. Ground ambulances, the ones that respond to nearly every 911 call, largely are not.
So families are left holding a bill for a decision they never got to make, one more version of the financial gap that pushes so many injured people toward medical liens just to get care in the meantime.
What I Learned Going Through the Appeal Myself
I have spent years working with people navigating claims denials, and I still found the process exhausting when it was my own family’s bill. A few things I’d tell anyone else standing where I stood:
A denial is not the end of the conversation. Find out what your next level of review is and use it. Don’t assume the first no is the final answer.
Get the denial reason in writing and read it closely. Ours came down to a network status question that had nothing to do with medical necessity and everything to do with contract language between the insurer and the ambulance provider, the kind of shareholder-driven decision-making that shapes far more of these outcomes than most families realize, and something no family in an emergency has any way to know or control.
Keep a paper trail. Every call, every representative’s name, every promise that a claim will be “resubmitted.” I was told twice that someone would handle it. Twice, months went by and nothing changed.
Don’t assume your doctor’s office or attorney is tracking this for you. It’s your bill and your appeal. Stay on it.
Why I’m Launching #GAINTheRightToCare
My family’s story is not unusual. A January 2026 KFF poll found that 33% of insured adults said their insurer had denied coverage for a service, treatment or medication their own doctor prescribed, within just the past two years.
That is not a fringe problem. That is a third of insured Americans.
So I’m asking people to do something simple. If you’ve had a claim denied, especially for care you had no real choice about receiving, record a short video with the hashtag #GAINTheRightToCare. Explain what happened and what you’d say to your insurance company if they were sitting across from you.
I’ll go first. My son needed an ambulance because he was unconscious and could not be moved. That claim should not have been denied. My message to UnitedHealthcare is simple: explain how a family in that situation is supposed to make any other choice.
If this happened to you, or to someone you love, share your story. The more of us who speak up, the harder it is to wave away these denials as one-off mistakes.
