Meet Dr. Hurley – a physician (and now a patient) bent on righting the wrongs of insurance denials

Dr. Daniel Hurley, a top ear, nose, and throat (ENT) doctor in greater Phoenix, never saw himself as an activist – and certainly not one who would challenge convention in his own field of medicine.

But Hurley’s outlook began to change about seven years ago when his basketball-loving teenage son was diagnosed with an unusual condition around both knees – osteochondritis dissecans – and the top sports-medicine doctors advising the family recommended surgery. Hurley was surprised after the successful operation when his health insurer told him they were denying coverage, after the fact. Then he was stunned when he learned the doctor who’d signed off on that denial was not a specialist in his son’s condition, but a pediatrician.

Hurley, 50, fought the decision and got it overturned, and that was the start of a life-changing journey, with an unexpected, wrenching plot twist. 

Today, Hurley is not just a physician and married father of three but also a cancer patient – in the fight of his life with chondrosarcoma – and a law student. His bold ambition is to put an eventual law degree to work in reforming a broken medical claims system.

“What are we putting people through?” Hurley asks himself now, as he comes to better understand the struggles of patients fighting for critical health care yet battling on a second front with their insurers and the confounding claims process. He says too many patients, especially those with life-threatening illnesses like his own, are dealing with “the added stress that we’re not even sure that this is going to be covered. And as a patient, it feels like people are trying to kill you – [that] that’s what they prefer.

“There are people in insurance trying to do the right thing,” Hurley added, “but somebody somewhere has to stand up and say, ’Who’s accountable?’”

If his cancer battle allows him to complete his law studies (mostly through distance learning) at the University of New Hampshire, he says he’d love to launch a non-profit organization that could help individual patients fight claims denials and accumulate data to make a case for sweeping reform. He’d prefer to work collaboratively with insurance companies to improve their systems, but if necessary, Hurley says he’d take his newfound legal knowledge and work with experts on a class-action lawsuit to force the industry to change.

Hurley also insists this isn’t about him, but the millions who struggle to get their health care approved, and in a timely fashion. He hopes public pressure will force insurance companies to improve as the devastating effects of their policies are exposed. Recent reporting has indeed laid bare what is becoming a national health crisis, with dangerous consequences for patients, but the challenge of forcing individual companies to change course is even greater when the entire industry is in lock step.

The numbers tell a part of the story. According to ProPublica, data from state and federal regulators currently show that the private health insurers who cover about 200 million Americans reject about one of every seven claims, a staggering number. What’s more, most patients – lacking the familiarity with the health care system that Hurley has acquired in two decades as an ENT doctor – never appeal these decisions. One study places the appeals rate at just 0.1 percent of rejections.

In recent months, outrage has mounted over the claims process because of new reporting on how the big insurers actually generate these rejections. One report, also by ProPublica, revealed that Cigna rejected some 300,000 requests for payment over a two-month period – aided by a system that allows physician reviewers to turn down a claim instantly, without opening the file. The news service identified one Cigna medical director who personally rejected 60,000 claims in just one month. These denials allow Cigna to save millions of dollars.

Hurley has discovered that what he encountered with the payment denial for his son’s leg surgery – that the reviewer was a pediatrician lacking clinical experience with such a case – was not a fluke. In dealing with his own cancer, and flurry of scans, surgeries and chemotherapy, he finds repeatedly that it’s not trained oncologists making critical decisions.

Hurley has about 100 pages of records documenting his dealings with eviCore – a Cigna subsidiary his insurer contracts with to review claims – involving a series of rejections for one $630 CT scan. The documents show that one doctor who rejected his request for payment was a family doctor, not an oncologist. When Hurley appealed that rejection, eviCore sent the file to a hematology oncologist in New Jersey – not licensed in Arizona – who also turned down the claim.

“I'm an ear, nose, and throat doctor,” Hurley said. “If I started reading people’s EKGs and recommending they get cardiac caths, how long would it be before the medical board knocked on my door and said, ’Excuse me, Dr. Hurley, we notice that you have no training or experience.” Yet Hurley found out-of-specialty reviews of important insurance claims by doctors who seem to make decisions on pre-prescribed guidelines, without looking at the patient’s chart.

In a recent essay that he self published, Hurley described a day in his life as a cancer patient, in which he and his doctors hoped to change his chemotherapy infusion and also begin a regimen of radiation treatments. For much of that day, he and his wife were on the phone dealing with a series of frustrating hold-ups in getting insurance approvals. Both new treatments were delayed but ultimately approved – helped by intervention from a care coordinator who has been assigned to Hurley’s claims – but he knows the average patient probably would not have been as fortunate.

Hurley had experienced such problems frequently during his more than two decades as an ENT. “For example, I’m talking on the phone with a GI doctor [for the insurance company] and I say: “Mr. Jones has sinusitis and needs a CT scan, and here’s why – and why am I talking to a gastroenterologist?” But he said he expected such mismatches would be less common with a disease as serious as cancer.

His sense of urgency about insurance reform increased dramatically around December of 2021 when – after months of hip and back pain – he was diagnosed with chondrosarcoma of the pelvic bone. It was after chemotherapy and surgery that removed much of his pelvis, forcing him to relearn how to walk, that a less-mobile Hurley applied and was accepted to law school.

Because much of his coursework takes place over Zoom, few if any of Hurley’s classmates at UNH’s Franklin Pierce School of Law know about his hopes for using his education as a vehicle for insurance reform. What’s more, he's facing the potential time constraint of his difficult medical prognosis. “The statistics say I’m not going to survive,” he says, but that hasn’t slowed his fight to beat cancer. 

Hurley calls his vision about how to pressure the industry – through direct aid to patients and publicizing egregious cases, building a database to amass the underlying evidence for policy changes, and the threat of a class-action lawsuit – “my three pillars.” He also believes that reforms can happen if and when the individual doctors who are denying these claims, or causing delays, have their work and their qualifications exposed to sunlight.

“One way to shut it down,” said Hurley of the rampant payment denials, “is to apply the same level of accountability that I have as a physician, when I have a practice, to the physicians who are making the decisions on the insurance side. When you apply that level of accountability – you can make that decision, but you’re going to be liable for it – then it shuts down very fast.”

Dr. Daniel Hurley’s story is a unique one, combining the knowledge that he’s acquired as a veteran physician and as a cancer patient with the determination to use what he’s learned to help the masses of patients dealing with what he has experienced. He says his goal would be to get the insurance industry to accept one basic principle: “Is this how I want my family treated?”