Nobody expects healthcare to be adversarial. When someone gets sick or needs medical care, the assumption is that the system exists to help them get better. Doctors will diagnose and treat. Insurance will cover necessary care. Hospitals will provide treatment and send patients home healthier. The whole apparatus is supposed to be on the patient’s side, working toward the same goal of better health.
That’s the theory anyway. In practice, healthcare often feels less like a support system and more like an opponent that needs to be fought at every turn. Insurance companies deny coverage and make patients jump through hoops to get it approved. Medical bills arrive with mysterious charges that nobody can explain. Different parts of the healthcare system don’t communicate with each other, leaving patients to fill the gaps. Getting answers to simple questions requires persistence that borders on harassment. The whole experience can feel designed to wear people down until they give up.
This adversarial dynamic isn’t what anyone signed up for. People are dealing with illness, injury, or chronic conditions that already require energy and attention. Adding the need to constantly fight the system—argue with insurance, chase down records, dispute bills, demand answers—turns healthcare into an exhausting battle on top of the actual health crisis.
Where the Fighting Starts
The battle usually begins with insurance. A doctor recommends a test, procedure, or treatment. Seems straightforward—doctor says it’s needed, insurance should cover it. But then comes the denial. The insurance company has decided this particular care isn’t medically necessary, or it requires prior authorization that wasn’t obtained, or there’s some policy exclusion that nobody mentioned upfront.
Now the patient has to fight. Call the insurance company and navigate phone trees. Get transferred multiple times. Explain the situation to representatives reading from scripts. Request supervisor reviews. File formal appeals with documentation from doctors. Wait weeks for decisions while treatment gets delayed. And if the appeal gets denied, start the whole process over at the next level.
This isn’t a rare occurrence. Insurance denials happen constantly, even for care that’s clearly medically necessary. The system seems designed to say no first and make patients fight for yes. Some people have the knowledge and persistence to win these battles. Many don’t, and they either pay out of pocket for care insurance should cover or skip the care entirely.
The Communication Battles Nobody Warns About
Getting information from healthcare providers can feel like pulling teeth. Simple questions—What did the test show? When should the next appointment be? Is this symptom normal?—often go unanswered for days or weeks. Phone calls go to voicemail. Messages sent through patient portals get generic responses that don’t address the actual question. Doctors’ offices claim they sent referrals that never arrived. Test results disappear into some administrative void.
Patients end up having to chase down their own information. Call repeatedly until someone answers. Show up in person because phone calls aren’t working. Contact multiple offices trying to track down records. Double-check that orders were actually placed and appointments actually scheduled. It’s exhausting work that shouldn’t be necessary but absolutely is if someone wants their healthcare to actually happen.
The reality of how a patient advocate helps in these situations becomes clear when someone finally has support navigating these communication battles—advocates know who to contact, what to say, and how to follow up effectively to get the information and action patients need without the runaround.
The problem gets worse when multiple providers are involved. Nobody seems responsible for coordinating care. The cardiologist doesn’t know what the endocrinologist prescribed. The surgeon didn’t get the test results from the primary care doctor. The hospital discharge planner didn’t communicate with any of the outpatient providers. Patients become the messengers between providers who should be talking to each other but aren’t.
The Billing Battles That Never End
Medical bills are their own special battlefield. Charges arrive months after treatment with no clear explanation of what they’re for. The amounts don’t match what anyone said to expect. Insurance explanation of benefits contradict what providers said would be covered. Trying to figure out what’s actually owed versus what’s a billing error requires detective work most people aren’t qualified to do.
Disputing charges means more phone calls, more documentation, more persistence. Bills get sent to collections while disputes are supposedly being resolved. Different offices—hospital, physicians, labs, imaging centers—all bill separately with no coordination. What should have been a single medical event generates a dozen different bills that trickle in over months.
And here’s where it gets really adversarial: sometimes the billing is just wrong, but proving it requires fighting. A service that was pre-authorized gets denied after the fact. A charge appears for something that never happened. Insurance processes a claim incorrectly and the provider bills the patient for the difference. Fixing these errors isn’t the system’s default—the default is that patients pay whatever they’re billed unless they fight hard enough to prove it’s wrong.
Why Everything Requires Pushing
Healthcare doesn’t happen automatically the way it should. Things that seem like they should be routine—scheduling follow-up appointments, getting prescriptions refilled, receiving test results—often require patients to push for them to actually occur. If nobody follows up, appointments don’t get scheduled. If nobody calls about the prescription, it doesn’t get renewed. If nobody asks about test results, they sit in a file somewhere.
This constant need to push back, follow up, and verify creates this battle mentality. Can’t trust that things will happen just because they’re supposed to. Can’t assume the system will work smoothly. Have to check everything, confirm everything, follow up on everything, or risk having care fall through the cracks. It’s a defensive posture that shouldn’t be necessary but is if someone wants to actually receive appropriate care.
The pushing extends to getting doctors to listen and take concerns seriously. Patients report symptoms that get dismissed. They advocate for additional testing that doctors resist ordering. They push for referrals to specialists when primary care doctors want to keep managing things that aren’t improving. Having to convince medical professionals to take health concerns seriously turns what should be collaborative care into an adversarial negotiation.
The Toll of Constant Fighting
This adversarial dynamic is exhausting in ways that go beyond the physical energy it requires. It’s emotionally draining to constantly have to fight for things that should be straightforward. It’s demoralizing to feel like the healthcare system is working against you rather than for you. It creates stress on top of whatever stress the actual health condition is causing.
People dealing with serious illness don’t have extra reserves of energy and patience to devote to fighting the system. They’re already managing symptoms, dealing with treatment side effects, worrying about their health and future. Adding hours of phone calls, appeals, follow-ups, and disputes on top of that is genuinely too much for many people to handle.
This is why some patients just give up. They stop fighting the insurance denial and pay out of pocket or skip the care. They stop chasing test results and just hope everything’s fine. They accept confusion and gaps in their care because fighting for clarity and coordination is too exhausting. The system wins through attrition—patients wear down and stop pushing back.
When Someone Else Can Fight the Battles
The difference between navigating healthcare alone and having support is stark. With support, someone else handles the insurance appeals, makes the follow-up calls, tracks down the missing information, disputes the incorrect bills. The patient can focus energy on actually getting better instead of fighting the system.
This isn’t about patients being weak or unable to handle things themselves. It’s about recognizing that fighting healthcare battles while also being sick is unreasonable to expect from everyone. Some people have the knowledge, persistence, and energy to do it. Many don’t, and they shouldn’t have to develop those skills on the fly during a health crisis.
What This Says About the System
The adversarial nature of healthcare isn’t an accident or an unfortunate side effect. It’s built into how the system operates. Insurance companies profit by denying claims. Providers minimize time spent on communication because it’s not directly reimbursed. Billing is deliberately complex in ways that make errors hard to catch. The system functions better for itself when patients don’t push back effectively.
Recognizing that healthcare is adversarial helps explain why it’s so difficult to navigate. It’s not that patients are doing something wrong or missing something obvious. The system really is set up in ways that require fighting, and not everyone is equipped for that fight—especially when they’re sick and their energy should be going toward recovery, not battling bureaucracy.
For people facing serious health challenges, understanding this dynamic is important. Healthcare won’t just work smoothly on its own. It requires advocacy, persistence, and often professional support to navigate successfully. That’s not how it should be, but it’s how it is. The battle isn’t optional for people who want to receive appropriate care—but having someone who knows how to fight these battles makes them winnable instead of overwhelming.
