2026年4月12日 / 美国东部时间上午9:41 / 哥伦比亚广播公司新闻
作者：苏珊·斯宾塞
市场营销主管马修·埃文斯饱受慢性背痛折磨长达八年，他将这种疼痛形容为“剧痛难忍”。到2024年时，他连走路都举步维艰。他已经尝试过所有无创治疗，医生也一致认为他需要接受手术。
但他的保险公司另有打算：“他们联系了我的主刀医生，说‘这位患者需要再接受六周的物理治疗’，”埃文斯说道。
于是埃文斯无奈地照做了，又忍受了六周痛苦的治疗。即便如此，他的保险理赔还是一次又一次被拒。“精神上就像坐过山车一样，”他说，“身体上我只想解脱痛苦。”
但解脱始终没有到来。七个月过去了，他的病情不断恶化。“每个看过我的医生都说，‘如果不尽快手术，受损部位可能会进一步恶化，甚至留下永久性损伤’，”他说。
全美有2700万美国人根本没有医保，所以埃文斯曾以为自己很幸运……直到自己真的需要用到保险。他认为保险公司有权审核理赔申请，“但它们不该拥有最终决定权”。
大多数美国人也认同这一点：73%的民众认为医保延迟赔付和拒赔是一个严重问题。
拒赔现状：保险公司如今如何影响医疗保健（《周日早间》栏目）
“并非医疗机构都是天使，保险公司都是恶魔，”作家凯瑟琳·亨普斯特德说道，“我们完全可以做一期关于医院定价的专题节目。但我认为消费者的感受是：‘医生们明明在采取行动，他们尽力去做那些他们说能帮到我的治疗。但突然冒出这么个中介机构，说他们不能这么做’。”
亨普斯特德是新泽西州普林斯顿罗伯特·伍德·约翰逊基金会的高级政策官员，这类情况她见得太多了：“我昨天刚听说一个病例，有人靠注射肉毒杆菌素来缓解偏头痛，效果一直很好，结果突然就被拒保了。”
杰夫·威滕表示，有20%的医保理赔申请——也就是五分之一——会被拒赔，这也是他和本·霍华德共同创立Sheer Health公司的主要原因。“我们的目标是让人们再也不用和自己的健康保险公司打交道，”霍华德说道。
Sheer Health
患者只需拍下账单照片并上传至Sheer Health平台。“我们会处理所有事情，”霍华德说，而他所说的“所有事情”确实名副其实。Sheer Health会代表每位客户与保险公司进行所有维权斗争，收费标准为每月40美元，或是在追回理赔款时收取一定比例的佣金。
《周日早间》栏目联系了美国健康保险计划（AHIP）——全国健康保险公司行业组织——征求评论。该组织部分回应称：“……医疗计划、医疗机构和制药商共同肩负着提供高质量医疗服务……的责任，要让服务价格合理……并更易于用户办理流程……”
但马修·埃文斯最初为背部手术申请理赔时，曾徒劳无功地挣扎了许久，直到他找到了Sheer Health。该平台审核了他的保险政策和授权申请的每一个细节，向保险公司提交了加急上诉申请，还和他的医生沟通，共同厘清授权问题。
“Sheer Health解决了所有问题，”埃文斯说，“我终于在10月中旬做了手术。”
术后效果如何？“我现在状态好极了。”
记者苏珊·斯宾塞与马修·埃文斯一同进行了拍摄，埃文斯正在做一项他说术后才能做到的事：沿街散步。哥伦比亚广播公司新闻
凯瑟琳·亨普斯特德认为，Sheer Health的成功恰恰反映了美国医疗体系的失灵：“我觉得我们需要这样的平台，这本身就很可悲。它只是在治疗症状而已——虽然这通常是个不错的商业点子，但并不能让我觉得‘好吧，这就是我们需要的全部解决方案’。”
她补充道，这本质上相当于为你的保险再买一份保险。
无论有没有Sheer Health，我们真正需要的都是一个能正常运转的体系。正如埃文斯所说：“保险公司把人们的生命握在手中。请认真对待这份责任。你们不是我们的主治医生，别摆出那副样子。”
更多相关信息：
- Sheer Health
- 凯瑟琳·亨普斯特德博士，罗伯特·伍德·约翰逊基金会高级政策官员
- 凯瑟琳·亨普斯特德所著《无保障：美国保险的故事》（牛津大学出版社），精装版及电子书均已上架亚马逊、巴诺书店及Bookshop.org平台
本报道由阿米尔·魏斯福格尔制作。编辑：乔治·波兹德雷克。
Fighting for health care claim approvals
April 12, 2026 / 9:41 AM EDT / CBS News
By Susan Spencer
Marketing executive Mathew Evins lived with chronic back pain for eight agonizing years. He described it as “excruciating.” By 2024, he had trouble just walking. He had exhausted non-invasive treatment, and his doctors agreed he needed surgery.
His insurance company had other ideas: “They went back to my surgeon and said, ‘Your patient needs another six weeks of physical therapy,’” Evins said.
So, Evins reluctantly complied, for six more pain-filled weeks. And even after that, his insurance denied coverage again … and again. “Emotionally, it’s like a roller coaster,” he said. “Physically, I just wanted relief.”
But no relief came. Seven months went by. His condition deteriorated. “Everybody I saw said, ‘This damage could become worse and/or permanent, if the surgery isn’t done as soon as possible,’” he said.
Twenty-seven million Americans don’t even have health insurance, so Evins had considered himself lucky … until he actually needed it. He agrees insurance companies should have a voice in coverage, “but they shouldn’t have the definitive voice.”
Most Americans agree; 73 percent say healthcare delays and denials are a major problem.
State of denial: How insurance companies impact health care today (“Sunday Morning”)
“It’s not the case that the providers are the angels and the insurance companies are the devils,” said author Katherine Hempstead. “I mean, we could do another show about hospital pricing. But I think that consumers feel like, ‘Hey, doctors are actually doing something. They’re trying to do something that they say will help me. And here is this intermediary coming in and saying that they can’t do it.’”
Hempstead, senior policy officer at the Robert Wood Johnson Foundation in Princeton, New Jersey, has seen this play out over and over again: “I just heard a story yesterday about someone who was really benefiting from taking Botox for migraines and, all of a sudden, denied.”
Jeff Witten says 20% of insurance claims – one out of five – are denied, which is a major reason why he and Ben Howard co-founded a company called Sheer Health. “Our goal is for people to never have to deal with their health insurance again,” said Howard.
Sheer Health
Patients can just take a picture of their bill and upload it to Sheer Health. “We’ll handle everything,” said Howard. And he means everything. Sheer Health will fight every insurance battle on behalf of every client, either for $40 a month, or for a percentage if they get money back.
“Sunday Morning” reached out for comment from AHIP, a national trade organization for health insurance companies. The group responded in part: “…health plans, providers and drugmakers share a responsibility to make high-quality care … affordable … and easier to navigate…”
But Mathew Evins struggled in vain to get coverage for his back surgery, until he found Sheer Health. Sheer reviewed every last word of his policy and authorization requests, submitted an expedited appeal to his insurance company, and worked with his doctor just to understand the authorization issue.
“Sheer got everything resolved,” Evins said. “And I finally had my surgery in mid-October.”
The outcome? “I’m doing great.”
Correspondent Susan Spencer with Mathew Evins, doing something he says he could not do before his surgery: walk down the street. CBS News
Katharine Hempstead thinks Sheer Health’s success speaks to our health care system’s failure: “I think it’s sad that we need that. It’s treating a symptom, you know, which is often a good business idea, but it doesn’t make me feel like, ‘Okay, that’s all we needed.’”
She agreed it amounts to buying insurance for your insurance.
What we clearly need, with or without Sheer Health, is a system that works. According to Evins, “It’s people’s lives that these insurance companies hold in the balance. Take that seriously. You’re not their medical practitioner. Don’t act like it.”
For more info:
- Sheer Health
- Katherine Hempstead, Ph.D., senior policy officer, Robert Wood Johnson Foundation
- “Uncovered: The Story of Insurance in America” by Katherine Hempstead (Oxford University Press), in Hardcover and eBook formats, available via Amazon, Barnes & Noble and Bookshop.org
Story produced by Amiel Weisfogel. Editor: George Pozderec.
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