07/20/2026
Insurance companies should not be allowed to practice medicine. And they must be held accountable.
Her doctor ordered an MRI. Her insurance company said no. Not medically necessary, they said, not until she finished six weeks of physical therapy.
She had already finished the six weeks. They had paid for it.
Her doctor appealed. The reversal took 38 days. She got the MRI immediately, and it found a sarcoma in her hip. The doctors at Memorial Sloan Kettering told her that a month sooner, they would have treated it with chemotherapy alone. Instead, they amputated her leg, her hip, and her pelvis. She died two years later.
Here is what the record shows about how that denial happened.
The insurance company published its own criteria for when an MRI is the next step: pain, a doctor's visit, six weeks of physical therapy. She met them. They did not follow their own criteria.
By law, the person reviewing a denial is supposed to be a doctor in the relevant specialty. A federal Inspector General report found the reviewers often are not, or have minimal experience in the specialty they are ruling on. That is against the law. Picture a pediatrician deciding a radiology appeal.
The attorney who brought the case named the motive: prior authorization hurdles are used "to delay and deny care," because that goes straight to the bottom line.
So the family sued. A federal judge threw the case out. The judge said: "This is tragic, but there's no law in New York that holds an insurance company accountable when they give medical advice that's wrong." He was not about to make new law, he said. The appeal went to the Second Circuit.
Sit with the asymmetry. Doctors, nurses, podiatrists, dentists, and hospitals are all held accountable, and it is written into law. Insurance companies are not. One might infer they have a lot of clout. They are big lobbyists.
This is not one family's fight. The American Medical Association and the medical societies of New York, Vermont, and Connecticut all filed friend-of-the-court briefs in the appeal.
Attorney Steve Cohen, who brought the case for the woman at the center of it, Mrs. Valenti, told the whole story on The Podcast by KevinMD, including what to do when it happens to you: appeal, and stay with the appeal. Do not let them wear you down. Get the denial in writing, with the name and specialty of the person who made it. Your doctor can write it in the chart: Dr. So-and-so from this insurance company denied the MRI.
Read the judge's words one more time:
"This is tragic, but there's no law in New York that holds an insurance company accountable when they give medical advice that's wrong."
Listen to the full conversation on The Podcast by KevinMD. Link in the comments.
