"It's Like a Second Job:" Communication Work in Patient Stories of Health Insurance Denials

Although health insurance denials are common in the United States, we know little about the labor they create for patients and families and lack systematic exploration of the communicative resources required to manage them. The goal of this study was to analyze written accounts of those who have coped with insurance denials to better understand the toll of this experience, especially the communication work required to manage denials. Using qualitative analysis, I examined stories of health insurance denials (N = 144) culled from Reddit users who posted in a subreddit dedicated to navigating challenges in the U.S. health insurance system. Results point to the various forms of communication work involved in understanding and responding to denials as consumers try to access needed care. This study also highlights factors that contribute to, and often complicate, the demands and required resources that characterize this form of communication work. The effects of health insurance denials add extensive labor that compounds the already burdensome work of coping with a health stressor.