Miranda Yaver, PhD, assistant professor of health policy and management at Pitt Public Health, will release her first book on April 23.
Coverage Denied: How Health Insurers Drive Inequality in the United States, published by Cambridge University Press, draws on survey research, administrative data, and interviews to examine why health insurance coverage is denied and how those decisions affect patients—often due to racial and economic inequities.
By combining interviews with original survey data, Yaver highlights the tens of millions of medical claims and prior authorizations denied by insurers each year and what those denials mean for people trying to access care.
“Insurers often argue that denials are acceptable because appeals processes exist,” she said. “But most patients don’t appeal, especially those from marginalized backgrounds.”
In other words, while patients technically have the right to challenge an insurance denial, many lack the time, resources or knowledge to navigate the process—meaning the denial often remains.
“So even if a denial isn’t technically final, we end up with what I call ‘rationing by inconvenience,’” Yaver said. “The accumulation of red tape prevents people from accessing care.”
Yaver uses the term to describe how complicated paperwork, phone calls and long wait times can discourage patients from pursuing treatment, effectively limiting access to care.
She said the book also has a strong historical dimension.
“Many of the delays and denials we see today are the result of decades of policy decisions that shifted the U.S. away from national health insurance and toward privatization,” she said.
“This book is not just about data on who gets denied care,” said Yaver. “It’s about the lived experience, the inequities and the political structures behind them. I wanted to tell that full story because people pay for health care every month, but too often they still can’t access it.”
While writing the book, Yaver conducted 111 interviews with patients, insurance executives, health care lawyers, patient advocates and claims processors to build a fuller picture of how insurance denials play out in real life.
For Yaver, many of these conversations were moving.
“Many patients shared deeply personal and painful stories,” she said. “One woman I interviewed had Still’s disease and was allergic to the only available treatment. She described managing her care from a hospital bed while coordinating with her insurer and even moving up her wedding so her partner could have power of attorney.”
Looking ahead, Yaver plans to write two additional books.
One, currently under review, will serve as a prequel and examine a law that limits how much insurers can be held accountable, helping explain why denials are so common. The other will explore the relationship between voter suppression and health policy, particularly how people with illness and disability are often underrepresented in the political process.
- Ava Dzurenda