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On February 1, 2023, Michael Kissling lost his leg. He was only 31.
The amputation had been years in the making—not because doctors were unsure how to treat him, but because his insurance company refused to pay for the procedure that might have prevented it. For nearly five years, physicians recommended a relatively simple intervention: a $3,000 vascular stent that could keep a critical vein open and stop the chain of complications that eventually destroyed the limb. The approval never came.
By the time Kissling entered the operating room, the cost of his care had climbed to more than a million dollars. His leg could not be saved.
“They deny the care,” Kissling says from his home in Pennsylvania. “And then that scenario that the doctor said would happen if I don’t get the care, happens.”
His case is unusually well documented. Over the years, Kissling kept denial letters, imaging studies, diagnostic reports, and the
correspondence between doctors and his insurer. The records show that multiple physicians identified the same anatomical problem when he was in his twenties and
recommended the same treatment. According to Kissling, the paper trail also demonstrates that UnitedHealthcare knew about the diagnosis — and repeatedly denied coverage anyway.
Yet in a broader sense, there is nothing unusual about his experience.
Data from KFF (formerly the Kaiser Family Foundation) shows that insurers denied roughly 19% of all in-network medical claims in 2023. When patients challenge those decisions before an Independent Review Entity — a neutral third-party reviewer — more than 81% are overturned across the industry. For UnitedHealthcare, the overturn rate rises to roughly 85%. More than eight out of every ten denials that reach independent review are ultimately judged to be wrong.
The catch is that very few patients ever get that far. Appeals are filed only about 11% of the time for Medicare claims, about 1% for marketplace plans, and less than 1 percent for employer-sponsored coverage. Insurers, the data suggests, have built their systems around that reality.
Kissling was born with May-Thurner Syndrome, a vascular abnormality that affects blood flow in the pelvis. In most people, the iliac artery and vein run parallel to each other. In Kissling’s anatomy, the artery crosses over the vein, compressing it and creating a point where blood flow can slow or clot.
His first clot came at 15. Another followed at 17. For several years afterward the condition was manageable, but by his late twenties the complications began to accelerate. Imaging studies revealed that the compressed vein in his left leg was collapsing under
pressure, leaving him vulnerable to repeated deep vein thrombosis.
Three separate physicians reached the same conclusion: he needed a stent to hold the vein open and prevent further clotting.
The device costs about $3,000.
UnitedHealthcare determined he did not qualify.
“They had prior knowledge that I met the qualification already,” Kissling says. “It really goes to show that they’re willing to deny anyone for the sake of retaining as much of the premiums as they can.”
Without the stent, the clotting continued. Blood pooled in his left leg, causing chronic swelling and escalating pressure in the surrounding tissue. Walking became painful. Eventually the restricted circulation began depriving the cells in his lower leg of oxygen and nutrients. The result was a series of non-healing ulcers — open wounds that the body cannot repair when blood supply is compromised.
The Food and Drug Administration has guidance for treating such wounds, including the use of bioengineered skin grafts designed to stimulate healing. By the time Kissling reached surgery, however, the damage had progressed beyond recovery.
Losing a limb did not end the medical fight. It introduced a new one.
Following the amputation, Kissling required a prosthetic leg. Rehabilitation typically begins with a basic “learner” prosthesis used during early recovery, after which patients transition to more advanced devices. For active amputees, the modern standard of care is a microprocessor-controlled knee — a prosthetic joint equipped with sensors and software that stabilize movement and dramatically reduce the risk of falls.
UnitedHealthcare denied coverage for that device as well.
The insurer cited Medicare’s functional classification system, known as K levels, which ranks amputees’ mobility from K0 (nonambulatory) to K4 (high activity). At the time, microprocessor knees were typically approved only for patients classified at K3 or higher.
Kissling’s physician, Dr. Stockhausen of Lehigh Valley Health Network, assessed him at K3 and later K4. The evaluation was supported by the Amputee Mobility Predictor (AMP), a standardized test used nationwide to determine prosthetic eligibility.
According to Kissling, the insurer ignored the results.
His doctor requested an additional AMP Pro evaluation, which measures mobility while the patient is wearing a prosthesis. An Independent Review Entity later concluded that UnitedHealthcare had violated the law by disregarding the test data, and the denial was eventually overturned.
But the reversal came after months of delay.
During that time Kissling relied on the temporary learner prosthesis — equipment meant for short-term rehabilitation rather than daily life. One afternoon he took his autistic daughter, Lily, to a park. At one point she ran toward the parking lot. Kissling tried to follow.
The prosthesis destabilized him.
“I remember being so embarrassed,” he says. “I haven’t been taking her out by myself anywhere—even a grocery store—since. Because while they’re busy saying that running is entertainment value only, in that moment, it was my parental protective capacity.”
The story of the microprocessor knee carries a final irony.
In 2024, the Centers for Medicare and Medicaid Services lowered the eligibility threshold for the devices from K3 to K2 — the level below where Kissling had already been evaluated. Federal officials cited new research showing that the prosthetics reduced fall-related injuries and fatalities. The studies also found that many patients initially classified at K2 improved to K3 or K4 once they were given equipment capable of supporting their rehabilitation.
In other words, the insurer denied Kissling a device that regulators later determined was appropriate for patients with lower mobility than he already demonstrated.
Over time, Kissling developed an unlikely expertise in the mechanics of insurance denials. He studies policy documents, analyzes denial letters, and cross-references the guidelines insurers cite when rejecting claims. On his website, AbilityForge, he archives the evidence from his case and outlines proposals for reform.
The data he highlights reveals how opaque the denial system can be. When KFF researchers examined the reasons insurers give for rejecting claims, they found that 34 percent were categorized simply as “other.” Another 18 percent were listed as administrative issues. Together, those two categories account for more than half of all denials and often provide little explanation. The justification most commonly assumed to drive coverage disputes — “not medically necessary” —appears in only about 5% of cases.
“It’s more likely to be denied because they said so,” Kissling says. “Not because it was a service excluded or because benefit limits had been reached. Majority of the time, simply because they said so.”
He offers a blunt example.
“The doctor says this person has broken their arm, and you can literally see the bone sticking out. And the insurance company is marking them not medically necessary.”
Traditional Medicare offers a revealing contrast. When fee-for-service Medicare denies a claim and the decision is appealed, roughly 28.7% are overturned. That figure is still significant, but far lower than the 81.7% industry average — and dramatically below the rates reported for large private insurers such as UnitedHealthcare,
Cigna, CVS Health, and Centene.
“You compare that to the Medicare overturn rate,” Kissling says, “and your error rate of eight out of ten becomes three out of ten.”
The appeals process itself, he argues, is undermined by attrition. Challenging a denial requires a physician to write additional documentation explaining why a treatment is medically necessary. Staff must gather records, locate the relevant policy language, and respond point by point to the insurer’s reasoning. For patients
already dealing with illness or injury, the process demands time, knowledge, and persistence that many simply do not have.
Most claims are never appealed.
Kissling refers to the system as the “denial echo chamber.” A claim is rejected, the patient is too exhausted or overwhelmed to challenge it, and the insurer retains the money. Even when appeals are filed, he says, internal procedures can cycle the claim through multiple reviews before it ever reaches a neutral third party.
“They have these ways to enforce their wrongful denial echo chamber,” he says. “Like, yeah, you didn’t see that complaint, just give that back.”
A recent example involved his wife, a licensed clinical social worker employed by a school district. Her physician prescribed Zepbound to treat rising A1C levels and insulin resistance. Under her previous insurance plan, the medication had been approved and produced measurable improvements: her A1C fell out of the pre-diabetic range, and continuous glucose monitoring showed the overnight glucose crashes she once experienced had disappeared.
When she changed jobs and insurance plans, the prescription was denied.
By examining the paperwork, Kissling discovered that the reviewing physician was a pediatrician. Pennsylvania’s Act 146 requires that coverage denials for specialized care be evaluated by a physician with equivalent board certification. In this case, that would have meant an adult bariatric specialist.
“Nothing but a bariatric doctor should have had any say in denying this,” he says. “Instead, they used a pediatrician to deny the care of an adult woman who has blood-based metrics that show the medicine was working exactly as intended.”
Kissling does not frame his advocacy as a call for confrontation. After the killing of UnitedHealthcare CEO Brian Thompson sparked widespread debate online, he told the Wall Street Journal that violence offered no solution.
“Killing Brian Thompson didn’t fix anything,” he says. “It put them under a magnifying glass for a couple months, and then they were back to the denials as usual.”
What he proposes instead is a structural shift in how denials are handled.
He calls the idea “the denial on trial.”
Under the model, the burden of proof would shift to insurers the moment a claim is rejected. Instead of requiring patients to initiate appeals, a denial would automatically trigger review by an independent third-party entity. During that review, a federally administered buffer fund would pay for the treatment so that patients could receive care immediately. If the reviewer determines the denial was wrongful — as happens in the vast majority of appeals—the insurer would reimburse the fund and potentially face financial penalties. Only when a denial is upheld and clear fraud by a provider is demonstrated would the cost fall elsewhere.
The logic, Kissling argues, is simple. In the current system the consequences of error fall primarily on patients. His proposal would place the risk on the institutions that make the decision.
He has filed a whistleblower complaint with the Senate’s Permanent Subcommittee on Investigations and shared documentation with the office of Senator Richard Blumenthal. Advocacy group People Over Profit NYC has also featured him on billboard trucks highlighting survivors of insurance denials, many of whom appear alongside photographs of family members who did not survive similar battles.
“For the investigatory committee to do something, they have to bring these people while they’re still alive to testify,” Kissling says. “I’m one of the few that are.”
Today he runs on a prosthetic blade provided through a grant from the Challenged Athletes Foundation. He is also undergoing evaluation at Johns Hopkins to determine whether mast cell activation syndrome may explain the recurrent clotting episodes that have repeatedly threatened his life — including a saddle pulmonary embolism, a blockage in the main artery of the lungs that is often discovered only during autopsy.
He hopes, when his lungs have healed enough, to run with his daughter again.
Michael Kissling documents his case and his reform proposals at abilityforge.net. Statistics on insurance denial and overturn rates are sourced from KFF Health Insurance data (2023).
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