Out of Patients
with Matthew Zachary
Welcome to 2026: The Year of the Patient where the sick shall inherit the ballot.
23,000 LinkedIn Followers and the Reality of US Healthcare
23,000 people follow me on LinkedIn. They are patients, caregivers, and clinicians dealing with insurance denials, medical debt, and delays in care. Here is what they are seeing every day and why it reflects a much larger problem across US healthcare.
An ICU Doctor Checked His Insurance Portal Every Day While His Daughter Was Dying Of Cancer. He Was Terrified They Would Kick Her Off.
Dr. Hesham Hassaballa is board certified four times over with 20 years in the ICU. When his daughter was getting chemo, he checked his insurance portal daily, terrified they would drop her. A physician. In the system. Earning a good living. Still terrified of financial ruin because his child got sick.
Prior Authorization Works Exactly as Designed and That Is the Problem
Prior authorization persists because it works for the system that created it. This essay explains how cost control, risk management, and delay shape patient outcomes, why reform keeps falling short, and what must change to align financial incentives with timely care.
What Happens If More Patients Appeal Insurance Denials?
Only 0.2% of patients appeal insurance denials, yet 80% succeed. This article examines how even small increases in appeals could shift insurer behavior, raise costs, influence Wall Street expectations, and reshape the economics of American healthcare.
American Harmcare: The System Working Exactly As Designed
A 30 year brain cancer survivor breaks down how insurance delays, denials, and red tape harm patients by design. This is not dysfunction. This is the business model.
Patients Should *NOT* Have To Write Policy Briefs
Sally Neely Nix manages chronic pain with nerve block injections. No opioids. Her insurer calls them experimental. So she built a policy brief and sent it to the CEO. While in extreme pain. Patients shouldn't have to become researchers to access care that works.
An Open Letter (Again) to Mark Cuban on Behalf of American Patients
Mark Cuban walked into the Senate with spreadsheets and receipts. He called PBMs a cartel. He saved Medicare $2 billion. But math doesn't show up at town halls. Receipts don't vote. Here's the hole in his equation and an invitation to fix it.
$1.7 Trillion Dollars. $54 Billion in Profits, 10 Million Fewer People.
In 2025, seven insurers generated $1.7 trillion in revenue and $54 billion in profit while covering 10 million fewer people. Premiums hit $26,993 for families. Public funding expanded. Consolidation deepened. The incentive structure driving American health insurance stands exposed.
The Health Insurance Industry is the new Joe Isuzu #TrustMe
Blue Cross Blue Shield says insurers protect patients from high drug prices. The real world shows delays, denials, and blame shifting while patients wait, appeal, and deteriorate. A closer look at how insurers deflect responsibility in the drug pricing debate.
How Prior Authorization Punishes the Sickest Patients
Insurance companies promise reform while patients absorb delay and denial. From IVIG rejections to cancer imaging hold ups, this essay documents how prior authorization functions in real life and why patients now recognize the pattern.
Blue Cross Blue Shield of North Carolina Tried to Kill My Friend
Blue Cross Blue Shield of North Carolina demanded another review of an already-approved, externally-reviewed IVIG infusion—48 hours before treatment. For a patient with life-threatening hypersensitivity reactions. This is how the denial machine works, and how one patient fought back and won.
Trump's Meeting With Insurers Is Already Over Before It Starts
24 million Americans watched premiums double overnight. Now Trump plans to pressure insurers who banked $543 billion in profits over a decade. The solution? HSAs—which create new revenue streams for the same industry while shifting costs onto patients who already can't afford care. This isn't reform.