Sheer Health fights insurance denials as claims delays soar

CBS News profiled marketing executive Mathew Evins on April 12, 2026, after years of chronic back pain turned "excruciating" and left him struggling to walk normally by 2024. His doctors agreed he needed surgery, but his insurer pushed him back to physical therapy, told his surgeon to try another six weeks, and then denied coverage again, showing how one refusal can turn into weeks of pain, paperwork and uncertainty.

Evins's case landed in a national system already strained by denials. KFF’s 2025 health tracking poll found 73 percent of Americans said healthcare delays and denials were a major problem, and KFF’s Jan. 27, 2025 analysis of HealthCare.gov plans found insurers denied nearly 1 in 5 in-network claims in 2023. The Commonwealth Fund later reported in 2026 that 1 in 5 privately insured adults said they experienced a coverage denial for doctor-recommended care. Public data on why those denials happen is still limited, which leaves patients and doctors guessing where the hold-up is.

After a denial, the next step is usually an internal appeal with the insurer. HealthCare.gov tells consumers they can challenge health plan decisions, and if the plan still refuses, an external review can move the case to an independent third party not connected to the insurer. For patients who have already waited through prior authorization, that appeal process can become the difference between getting care and letting a condition worsen.

The consequences are not only financial. CBS also noted that 27 million Americans do not have health insurance, but insured patients face their own vulnerability when a needed procedure is blocked. Sheer Health says it steps into those fights by helping consumers deal with denied claims with no clear explanation, surprise medical bills and out-of-pocket costs, and disputes and appeals. Sheer Health said it was featured on CBS Sunday Morning, which previewed the segment as "The Money Issue."

The biggest reforms now on the table would make denials rarer and faster to overturn. In June 2025, more than 60 major health insurers pledged to standardize electronic prior authorization, reduce the number and scope of services that require it, and improve continuity when patients change plans. For patients already trapped in the denial process, fewer prior-authorization hurdles and quicker reviews would ease the longest delays before treatment ever reaches the exam room.