After UnitedHealthcare denied his surgery, Donald Grant took his 11-page legal and medical appeal straight to UnitedHealth Group CEO Stephen Hemsley — and got his request approved.
Last month, Elizabeth Nicholas wrote in Vanity Fair about being diagnosed with breast cancer at 36 and then watching her insurer refuse to pay for a recommended course of chemotherapy. Her oncologist delivered the news. Nicholas’s response was to email the company’s CEO directly, laying out her case in plain, human terms rather than routing it through the black box of the standard appeals process.
I mentioned her essay briefly in the piece we published recently on artificial intelligence and health insurance denials. Since then, another case landed in my inbox that is worth looking at alongside hers. This patient fought back with an extraordinarily detailed appeal that shows just how sophisticated patients are becoming when an insurer denies critically important care.
You have to write a letter built to break through the corporate bureaucracy
On September 12, I was copied on an email from Donald E. Grant Jr., a 49-year-old industrial-organizational psychologist in Valley Village, California. It was addressed to UnitedHealth Group CEO Stephen Hemsley and copied to more than a dozen other people, including UnitedHealthcare executives, Optum’s chief medical officer, a California state senator, the lieutenant governor’s office, Attorney General Rob Bonta, and two health care reporters. Attached was Grant’s formal appeal, which runs eleven pages and cites the Code of Federal Regulations, ERISA case law and Department of Labor guidance, chapter and verse.
Grant’s situation was — and still is— serious and getting worse. A fall in August 2025 caused the sudden loss of sensation in his legs. Workup found severe congenital cervical stenosis. An in-network surgeon performed a two-level artificial disc replacement in December 2025, but it failed to adequately decompress his spinal cord. By March 2026, imaging showed new myelomalacia — scarring inside the cord itself that wasn’t there before surgery — spreading across four vertebral levels. He now has bilateral foot drop, no sensation in his lower legs, a hand going numb and weak, and new bowel and bladder problems. His surgeon, Dr. Hyun Bae at Cedars-Sinai, is a leading authority on multilevel cervical arthroplasty and its revision — one of the physicians who ran the original FDA trials for the very device implanted in Grant’s neck.
UnitedHealthcare has no in-network surgeon with comparable qualifications, and Grant argues none can safely operate within the window his deteriorating spinal cord allows. The surgery is scheduled for October 14. Everything but the surgeon himself — the hospital, the anesthesia team — is in network. He’s asking UnitedHealthcare to cover Dr. Bae at the in-network rate through a network exception.
What sets Grant’s letter apart isn’t the medicine. It’s the legal architecture around it, and that’s because he had help from Claimable, the AI-assisted appeal service founded by Warris Bokhari. The letter invokes the federal urgent-care claim regulation and its 72-hour decision clock. It demands that the reviewing physician be named, board-certified in the relevant specialty, and walled off from whoever issued the original denial — citing the exact subsection of the claims-procedure regulation that requires it. It requests the complete claim file and designated record set under both ERISA and HIPAA. It puts UnitedHealthcare on notice to preserve every internal record connected to the claim. And it names, as a co-recipient with real leverage, David Ellison — chairman and CEO of Paramount Skydance, the company whose self-funded plan is actually paying these claims, and therefore the ERISA plan administrator and fiduciary who can lean on UnitedHealthcare from above.
There’s also a section I want to draw special attention to, because it’s the clearest expression I’ve seen from a patient of a concern I’ve been raising for months: Grant explicitly demands that no algorithm, predictive model, or automated tool be used at any stage of deciding his appeal, and he wants written confirmation of that in the response. He backs the demand with a tight legal and factual history — ProPublica’s reporting on Cigna’s PXDX system, the nH Predict litigation against UnitedHealth, the Senate Permanent Subcommittee on Investigations’ 2024 report on Medicare Advantage denials, and California’s Physicians Make Decisions Act. His argument is that a federal regulation most patients have never heard of already requires what California’s algorithm-ban requires: a qualified human being in the relevant specialty, not a model trained on aggregate outcomes, deciding whether his particular spinal cord can wait.
The strategy worked. Grant told me this week that UnitedHealthcare has now approved both Dr. Bae and the procedure at the in-network rate, clearing the way for the October 14 surgery. And Grant was careful to give the insurer credit for how it handled the process once his appeal was underway. He said UnitedHealthcare employees were responsive and patient in helping him understand the approval and what he would owe out-of-pocket at the in-network rate.
“I realize this is not always the case,” Grant wrote, “but this time it worked out well.”
That’s an important part of this story too. The point isn’t that every appeal ends badly, or that an insurer can’t respond appropriately when a patient pushes back. Grant got the result he was asking for. But it took an eleven-page appeal, detailed medical and legal arguments, and an email that put executives, public officials and reporters on notice to get there. His case shows that patients can successfully challenge these decisions. It also raises a harder question: How many patients would have known how to mount the same fight?
The strategy patients weren’t supposed to have
I’ve been telling patients for years to do exactly what Nicholas and Grant did: If a denial threatens your life or your ability to function, don’t just work the internal appeals queue quietly. Go to the top. Email the CEO. Loop in the plan sponsor if you’re on an employer plan. Contact your state insurance commissioner or attorney general. Call your legislators. Talk to a reporter. Be the squeaky wheel. Insurers built the appeals system to be slow, opaque, and easy to lose interest in. They know that discourages patients to give up. Do not give up or even go through the normal bureaucratic nonsense if time is of the essence.
The nation’s largest health insurer says it is eliminating prior authorization requirements for 1,700 medical codes. Look under the hood and the announcement is considerably less impressive.
Nicholas didn’t have Grant’s legal scaffolding. She had her own voice and the reach of a national magazine. Grant has a documented clinical emergency, a sympathetic and well-known plan sponsor CEO, a growing list of public officials on notice, and — importantly — professional help translating his situation into the language ERISA regulators and general counsel offices actually respond to.
There’s a less comfortable layer here too. Grant had to do all of this — hire or enlist expert help, cite the C.F.R., demand a litigation hold on internal records — just to get the process ERISA already promises every plan member by law: a full and fair review, decided by someone qualified, free of algorithmic shortcuts. Most people denied a surgery their doctor says they need don’t know these regulations exist, let alone have the resources or stamina to invoke them. That gap is the real story underneath both of these cases. The system shouldn’t require this level of sophistication to work as designed. It just doesn’t work reliably without it.
II’ll be watching to see whether Grant actually gets his laminoplasty on October 14 with Dr. Bae in the room.
