Nala White at her home in Round Rock, Texas in August.Harmon Li for NBC News

Her spine surgery was denied. Doctors say it's all too common.

Insurance denied 18-year-old Nala White’s surgery for degenerative disc disease. After NBC News reached out, it was approved the next day.

Aug. 20, 2025, 5:19 PM EDT

By Aria Bendix and Ellison Barber

By the time she graduated high school, the back pain that Nala White first noticed at age 13 had radiated to her left leg, creating an unbearable sensation of pins and needles. The mere act of standing at her graduation ceremony was excruciating.

“I had to sit there and dig my nails into my palms and just bear through it,” White said.

At home, a simple walk from her bedroom to the kitchen brought her to tears. And a trip to the mailbox down the street would cause her leg to burn, forcing White to crouch or sit for relief.

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Family battles insurance company for surgery coverage

04:04

The 18-year-old from Austin, Texas, was diagnosed three years ago with degenerative disc disease, the same condition her mother developed as a teenager. Most people develop the condition as spinal discs wear down naturally with age, but early onset can run in families.

In severe cases, spine surgery is often the best option to alleviate the debilitating pain and numbness that are hallmarks of the disease. Multiple doctors recommended that White get surgery to remove part of the bone that was compressing her nerves.

However, her insurance company, Aetna, twice refused to cover the surgery, saying it was “not medically necessary.” Doctors who treat degenerative disc disease say it’s an all-too-common scenario.

White’s predicament comes at a time of growing animosity against insurance companies over denied claims or pre-authorization requests, which require an insurer to sign off on a medical service before it happens. A 2023 survey from Premier, a health care data and consulting company, found that nearly 15% of claims submitted to private insurance companies are initially denied, and more than half of denials are overturned, usually after multiple appeals. Frustrations with insurance companies grew louder last year following the killing of UnitedHealthcare chief executive Brian Thompson, which is widely suspected to have been motivated by grievances with the health insurance industry.

Nala White, right, and her mother, Christine Byers at a kitchen counter with medications on top — White and Byers at their home in Round Rock on Monday.Harmon Li for NBC News

“Spine surgery tends to be one of the more likely things to be denied,” said Dr. Anthony DiGiorgio, an assistant professor of neurological surgery at the University of California, San Francisco, who was not involved in White’s care.

DiGiorgio said the surgeries can be particularly expensive (up to $35,000 in some cases without insurance). And because degenerative disc disease is common, he said, doctors can sometimes over-recommend surgery when other interventions like physical therapy would suffice. Even then, doctors might not always agree on what approach is best.

Some people with degenerative disc disease may have no symptoms at all. A 2015 analysis found that 37% of 20-year-olds and 96% of 80-year-olds who did not have back pain had some degree of disc degeneration. For others, the back, neck or leg pain is so severe they have trouble walking or performing daily activities.

A split composite image of Nala White lifting up her shirt to reveal scars on her back next to a phone showing a photo of said scar, left, and Christine Byers helping Nala White adjust a back brace — White reveals her scar from her spinal surgery that was done in July; Byers helps White with the back brace she regularly wore before her spinal surgery.Harmon Li for NBC News

“There’s a lot of gray zone decision-making in spine surgery,” DiGiorgio said. “You could show a patient presentation, an MRI, to five spine surgeons and get 10 different answers.”

Dr. Randall Dryer, an orthopedic surgeon at Central Texas Spine Institute who treated White but did not perform her surgery, said doctors often have to make a convincing case to insurance companies.

“The insurance companies refuse to accept the fact that surgery for degenerative disease is effective. They will say it’s because the medical literature doesn’t support it, but they take cherry-picked articles that support their case, and they tend to downplay other literature that would indicate that surgical treatment is effective,” Dryer said.

An Aetna spokesperson pointed NBC News to two published analyses that found no clear benefits from spine surgery over a nonsurgical intervention. But other studies have shown that spine surgery is superior to nonsurgical treatments, such as physical therapy or injections, and reduces a patient’s disability.

White’s father, Wrath James White, is the policyholder for her insurance plan. He said he was shocked to receive a letter from Aetna saying their request for coverage had been denied.

A hand holds a phone showing a video of Wrath James White — White views a video her father, Wrath James White, posted to social media about her struggle to secure insurance coverage from Aetna for her spinal surgery.Harmon Li for NBC News

“I had never had insurance reject a legitimate claim before, and my daughter’s pain seemed about as legitimate as you can get,” he said.

When his daughter was diagnosed, the family tried less invasive approaches than surgery such as physical therapy, steroid injections and anti-inflammatory pills. But it became clear to them — and to White’s doctors — that spine surgery was the only option to alleviate her pain.

“I did everything I possibly could for four years to avoid doing surgery on her,” Dryer said. He noted in a 2022 report that White was “miserable” and “I could significantly improve the patient’s condition with a simple decompression and discectomy,” referring to surgical procedures to remove compression on her nerves.

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A report from White’s surgeon in April said she had “failed multiple rounds of physical therapy and pain management and as such I feel she has reached a point for surgical intervention.”

White’s parents ultimately decided to set up a GoFundMe to raise money for the surgery. In a matter of days, they received more than $33,000 in donations — close to the amount they were quoted for White’s surgery, including hospital fees, anesthesiology and doctor’s fees.

Wrath James White said he believes a lot of those donations were “small and silent protests.”

A split composite image showing Christine Byers, left, showing her neck scars and an x-ray image on her phone, and right, hands close up on a sketch on a drawing pad — Byers, who also has degenerative disc disease, shows her neck scar from spinal surgery; White draws on a sketch pad.Harmon Li for NBC News

White underwent surgery on July 18. NBC News reached out to Aetna on July 31 to inquire about why her coverage was denied. Aetna said in an email the following day that it had approved coverage for White’s surgery on Aug. 1 “based on additional documentation provided by Ms. White’s surgeon.” The family said they are expecting a $3,700 reimbursement for the doctor’s fee from Aetna, but have not heard back about additional reimbursements.

“The system does not work,” Wrath James White said. “It is not designed to get people healthy.”

DiGiorgio, the California surgeon, believes it’s important for insurance companies to publicly disclose their requirements for covering spine surgery, so doctors know what to submit for pre-authorization. (Aetna does so on its website.)

Some insurers, such as UnitedHealthcare and Highmark, have also implemented “gold carding” programs, which allow surgeons with a track record of good decision-making to bypass the pre-authorization process. DiGiorgio said that could help speed up approvals for spine surgery. Texas, where White lives, passed a “gold card” law in 2021 that exempts providers from needing pre-authorization if they have at least a 90% approval rate on past pre-authorization requests. But the law does not apply to certain insurance plans, such as Medicaid or self-funded employer plans.

In White’s case, the surgery was life-changing. Her body is still healing, but she said her leg pain is gone. She starts community college next week — a dream she wasn’t sure was possible before surgery.

“Now I’m hopeful I can live normally, just be happy,” she said.

Aria Bendix

Aria Bendix is the breaking health reporter for NBC News Digital.

Ellison Barber