Healthcare Struggles Amid Cancer Battles

Tracy Hurley recalls how watching her husband face cancer at the end of 2021 was truly heartbreaking. “It was awful. I lived in fear every single day,” she shared. The struggle was compounded by numerous disputes with insurance companies. “No family should have to fight for their lives to get recommended treatments from their doctors,” she lamented.

Many Americans echo Tracy’s frustrations, finding it difficult to access healthcare—either due to high co-pays or, as in Dan Hurley’s case, insurance denials for necessary tests and treatments. Dan, an ear, nose, and throat surgeon himself, was well-acquainted with navigating the complexities of insurance for his patients.

“Yet, we faced many hurdles,” Tracy explained. “If doctors are having such a tough time getting treatment approved, what about those without medical expertise? What do they go through daily?”

Dan was a passionate hiker until relentless back pain led to a diagnosis of chondrosarcoma, a rare bone tumor. To save his life, the tumor required removal, along with his hip. Sadly, insurance only covered part of the expenses.

“He faced denials for many treatments—PET scans, CT scans, chemotherapy, radiation therapy, and even certain medications needed prior approval,” Tracy recounted. The insurance company’s reasoning for these denials? Simply stated, they deemed them “not medically indicated.”

“Make their lives as difficult as possible.”

Ron Howrigon, a consultant with two decades of experience in health insurance, stated, “Insurance companies are aware that 5% of enrollees account for 50% of total costs. There’s a strong financial incentive to complicate their lives.” He further expressed that this model is unique—unlike other industries, where product usage increases profit, insurance profits hinge on limiting customer utilization.

The frequency of treatment denials by insurance companies can be hard to measure, as they are only required to report denial data for plans obtained through healthcare.gov.

A CBS News analysis covering around 1.3 billion federal health insurance claims over three years indicated that in 2024, insurers denied about 19% of in-network claims, equivalent to roughly 1 in 5. For United Healthcare, the largest insurer, this marked a decline from previous years when denials reached one-third of federal claims.

Though they did not provide supporting data, United Healthcare mentioned an overall rate of 10% for initial denials across all plans. Moreover, they clarified that self-insured employer plans, which cover about 65% of 165 million Americans with employer-sponsored insurance, can affect coverage decisions.

“Employers determine what is covered for their employees,” United explained. “The health insurance company merely handles administrative tasks.”

“Insurance doesn’t cover”

Dr. Elizabeth Potter, a surgeon treating breast cancer patients in Austin, Texas, asserts that insurance companies have complicated the path to health. “Insurance denials drive up costs,” she stated. “I have staff dedicated to handling insurance issues. There seems to be a wall wherever you turn.”

Take the case of Jeannie Lee, a 40-year-old mother battling breast cancer. She was ready for a double mastectomy and lymphovenous bypass, a procedure that could have happened weeks earlier, but her and her husband’s insurance refused to cover it.

Dr. Potter highlighted the risks Lee faces, like developing lymphedema, which severely hampers arm function and can cause persistent pain. “I’m 40 years old with three young kids. This surgery is crucial,” Lee emphasized.

Thanks to a newfound nonprofit led by Dr. Potter, Lee secured financial aid. “This patient ended up needing extra surgery due to insurance complications,” Potter noted. ”We could have done everything at once.”

Dr. Potter often finds herself defending her medical choices to insurance representatives, sometimes having to explain details to those unfamiliar with her specialty. In an instance, a video she shared online raised eyebrows, revealing just how out-of-touch some insurance directives can be.

Shortly after posting, she received a threatening letter from her insurer, warning of possible legal action for defamation. “I care for my patients, and they want to silence me,” she said. When asked if she felt scared, she admitted, “I am scared.”

Although United Healthcare hasn’t pursued legal action against her, they declined an on-camera interview, asserting the emergency call she received was misdirected and that doctors should not have to pause surgeries for insurance inquiries.

“It was such a gut punch.”

Miranda Yarber, an assistant professor at the University of Pittsburgh, mentions that insurance companies know only a small percentage of people will appeal claim denials. “We’re all vulnerable,” she remarked. “It’s not just about denial; many give up entirely.”

Yarber referred to this as “Rationing due to inconvenience,” noting that many are oblivious to their right to appeal. “While successful appeals can help, those facing aggressive illnesses, like Dan Hurley, often lack the time to navigate the process. He spent much of his last months dealing with insurance calls, line by line,” Tracy revealed.

Tracy believes insurance companies should be held to the same standards as healthcare providers, facing consequences for denying critical treatments. “Denying care is a medical decision,” she argued. “If I make a poor treatment choice, I’m accountable just the same.”

Dan Hurley passed away on August 3, 2023. Just a week later, his widow received a startling letter from the insurer, demanding $80,000 for a previously pre-approved chemotherapy course that was now rescinded. “To get that letter the day after his passing was shocking,” she said. “Unbelievable, right?”

Tracy is continuing Dan’s fight, torn between pride in advocating for him and the pressure to honor his memory. “Part of me thinks he’s proud of me, but I can almost hear him saying, ‘Let’s go, keep pushing forward.’ That’s just who he was.”