Health Insurance Gaslighting

Health Insurance Gaslighting: When the System Makes You Doubt What You Know Is True

At AKG Advocacy, we often say: the insurance system is designed to make you give up.
One of the most powerful ways it does that is through something we call health insurance gaslighting.

What Is Health Insurance Gaslighting?

Health insurance gaslighting happens when an insurance company (or its representatives) denies, delays, or misrepresents information in a way that makes you question your understanding of your own coverage, your doctor’s orders, or your right to care.

It’s the feeling of:

• “Maybe I filled out the form wrong.”

• “Maybe my doctor didn’t code it right.”

• “Maybe this medication really isn’t covered.”
  When in reality, you did everything right—but the system is designed to confuse you into giving up.
  
  

Common Examples of Health Insurance Gaslighting

• “It’s not covered because it’s not medically necessary.”
  Even when your doctor documents that it is medically necessary.

• “You need prior authorization.”
  You submit it. Then they lose it. Then they say it was sent to the wrong department. Then they tell you it’s still “pending.”

• “We don’t cover compounded or off-label medications.”
  Even when Medicare regulations, clinical studies, and federal policy say otherwise.

• “You can appeal, but it probably won’t change anything.”
  (Translation: They hope you won’t try.)
  
  

These tactics are meant to wear you down—emotionally, mentally, and financially—until you accept their decision without a fight.

Why It Matters

This isn’t just paperwork or “policy language.” It’s gaslighting on an institutional level—designed to make patients, caregivers, and even providers doubt their own knowledge.
It delays treatment, increases suffering, and erodes trust in healthcare altogether.

When you’re told “no” enough times, you start to wonder if you were wrong to ask in the first place.
That’s exactly what they want.

How to Recognize and Respond to Insurance Gaslighting

1. Document everything.
   Keep a record of every call, name, date, reference number, and promise made.

2. Ask for explanations in writing.
   If they claim something “isn’t covered,” ask them to cite the exact policy, regulation, or formulary rule.

3. Don’t internalize their tone.
   Many representatives read from scripts that intentionally shift blame to the patient or provider. Remember—you’re not the problem.

4. Use your right to appeal.
   Denials can often be overturned with clear evidence, citations, and persistence.

5. Bring in an advocate.
   Sometimes having a patient advocate or caregiver on your side changes everything. Two voices are harder to ignore than one.
   
   

AKG Advocacy Is Here for You

At AKG Advocacy, we help patients:

• Understand denial letters and policy language

• Identify misinformation or manipulation in insurer communications

• Draft strong, evidence-based appeals

• Regain confidence after repeated denials and dismissals

Because you shouldn’t have to fight alone—and you should never have to doubt what you know to be true.

When they try to gaslight you, remember:
🩺 You are the expert on your body.
📋 Your doctor is the expert on your care.
⚖️ And we are here to make sure your insurance company doesn’t rewrite the truth.

Dealing with Difficult Representatives

Sample Dialogue: How to Handle Health Insurance Gaslighting

Scenario:  A patient is calling their health insurance company after receiving a denial for a medication their doctor prescribed.

Insurance Representative:
“I’m sorry, but your medication isn’t covered because it’s not medically necessary.”

Patient:
“My doctor documented the medical necessity in the prior authorization and included supporting records. Can you please tell me exactly what criteria were used to make that determination?”

Representative:
“It’s just not something your plan covers. You can always try a different medication.”

Patient:
“I understand, but I’d like clarification. Could you please read me the policy language or clinical criteria your plan used to deny this medication? I need that information for my appeal.”

Representative:
“Well, even if you appeal, these decisions rarely get overturned.”

Patient:
“I appreciate your honesty, but I’m aware that appeals are my right under federal law and that many denials are overturned once proper documentation is reviewed. Please send me the denial letter and criteria in writing so I can move forward.”

Representative:
“It looks like your doctor didn’t complete the prior authorization correctly.”

Patient:
“Thank you for letting me know. Could you please specify which section or form was incomplete so I can have my provider address it directly? I’d also like the fax number or online portal where resubmissions should be sent.”

Representative:
“I can’t guarantee it’ll make a difference.”

Patient:
“I understand you can’t guarantee an outcome, but accuracy and documentation do make a difference. I’d appreciate a reference number for this call so I can note it in my records.”

Representative:
“Is there anything else I can help you with today?”

Patient:
“Yes — please confirm that a written denial letter will be mailed or available in my portal within 72 hours, and that it includes the reason for denial and my appeal rights under Medicare regulations.”

Why This Works

This approach helps you:

• Stay calm and fact-focused — gaslighting loses power when you don’t react emotionally.

• Shift the burden back to the insurer — they must prove why something isn’t covered.

• Document everything — every call, date, name, and quote builds your paper trail.

• Assert your rights — you remind them you know the system and will follow through.
  
  

🛡️ AKG Advocacy Tips for Fighting Insurance Gaslighting

1. Always get names and reference numbers.
   (“Thank you. Can you please spell your name for my notes and give me a reference number for this call?”)

2. Request written confirmation.
   If they say “it’s not covered,” you have the right to see that policy in writing.

3. Don’t let them minimize your right to appeal.
   If they discourage you, remind them appeals are federally protected.

4. Be polite, but assertive.
   You’re not being rude — you’re being thorough.

5. Use scripts like this as a template.
   Keep one next to your phone or in your AKG Advocacy “Insurance Call Log.”
   
   

💬 “Gaslighting only works when you start to doubt yourself.
You know your coverage, your care, and your rights — don’t let them convince you otherwise.”
— AKG Advocacy