Mathew Evins spent eight years trying to manage chronic back pain before he finally got to a point where doctors agreed surgery was necessary. By 2024, walking had become hard enough that even ordinary days felt like work. He’d tried non-invasive treatments, exhausted the usual options, and still—his insurance company, in his telling, insisted on more waiting.
Evins said the insurer went back to his surgeon and told him he needed another six weeks of physical therapy. So he complied, even though it meant more pain-filled weeks with no clear end in sight. Then, after that, coverage was denied again—again—each time putting the surgery he needed a little farther down the road. “Emotionally, it’s like a roller coaster,” he said. “Physically, I just wanted relief.” The relief never came until much later.
Misryoum newsroom reported that Evins eventually learned how quickly a medical recommendation can turn into an authorization fight. After seven months, his condition deteriorated, and he says the people around him kept warning that the damage could become worse and/or permanent if surgery wasn’t done as soon as possible. He also described the bitter timing of it all: Twenty-seven million Americans don’t even have health insurance, so he’d considered himself lucky—until he actually needed it.
Most Americans see the same problem, according to Misryoum reporting and broader survey findings summarized here: 73 percent say healthcare delays and denials are a major problem. Evins said insurance companies should have a voice in coverage, but they shouldn’t have the definitive voice. Katherine Hempstead, an author, put it a little differently. “It’s not the case that the providers are the angels and the insurance companies are the devils,” she said. “I mean, we could do another show about hospital pricing. But I think that 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.’”
Hempstead—senior policy officer at the Robert Wood Johnson Foundation in Princeton, New Jersey—said she’s seen the pattern repeatedly. “I just heard a story yesterday about someone who was really benefiting from taking Botox for migraines and, all of a sudden, denied,” she said. Jeff Witten says the denial pipeline is built into the system: he and Ben Howard co-founded Sheer Health, pointing to a figure that 20% of insurance claims—one out of five—are denied. The company’s pitch is direct: patients shouldn’t have to keep wrestling their insurer once they’re already trying to get care.
Sheer Health’s approach is that people can take a picture of their bill and upload it for the company to handle. “We’ll handle everything,” Howard said. Misryoum editorial desk noted the service includes fighting insurance battles on behalf of clients, either for $40 a month, or for a percentage if they get money back. Evins described what that looked like on his end: Sheer reviewed the details of his policy and his authorization requests, submitted an expedited appeal, and worked with his doctor to understand the authorization issue. “Sheer got everything resolved,” he said. “And I finally had my surgery in mid-October.” He added, somewhat simply, “I’m doing great.”
Misryoum newsroom also noted that Sunday Morning reached out to comment from AHIP, a national trade organization for health insurance companies. The group responded in part: “…health plans, providers and drugmakers share a responsibility to make high-quality care … affordable … and easier to navigate…”. Hempstead said Sheer Health’s success underlines the system’s failure. “I think it’s sad that we need that. 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.’” She agreed it amounts to buying insurance for your insurance. What she and Evins keep circling back to, though, is a basic demand: a system that works.
Evins doesn’t mince words about who’s calling the shots. “It’s people’s lives that these insurance companies hold in the balance,” he said. “Take that seriously. You’re not their medical practitioner. Don’t act like it.” After his surgery, he described doing something he says he could not do before—walking down the street. On a crisp morning, that small detail matters; it’s the sound of his shoes on pavement, more relief than anyone wants to have to negotiate.
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