‘Is your plan for me to die?’: Cancer patients fighting for their lives — against health insurance red tape

Working for one of the largest health insurers in the country, Rachael Proffitt understands more than most Americans the complexities of navigating insurance red tape.

So, when the 40-year-old ran into problems with her own health coverage after being diagnosed with a particularly aggressive form of breast cancer this year, she naturally believed her employer, Aetna, would get to the bottom of it as swiftly as possible.

“I thought that if I came to them with an issue, they’d immediately resolve it since I worked for them,” she told The Independent.

She was wrong.

Instead, Proffitt, of Louisiana, became one of a growing number of Americans with cancer to experience a denial or delay for treatment at the first hurdle — prior authorization — a cost-control measure implemented by insurance companies where their approval must be given before treatment can start.

Prior authorization has caused harm and even contributed to the deaths of some cancer patients, according to a 2024 American Society for Radiation Oncology survey, with 7 percent of physicians reporting that the process led or contributed to the death of a cancer patient in their care.

In fact, one in 10 cancer patients reported that an insurance request was initially denied, and one in five waited two weeks or more for a decision, according to a 2025 report by CancerCare. Despite the delays, insurers overwhelmingly approved initial requests (89 percent) according to the survey, but such holdups to chemotherapy widely result in patient anxiety, studies have shown.

At the Gayle and Tom Benson Cancer Clinic in New Orleans, Proffitt went through six rounds of chemotherapy and a double mastectomy in the summer to attack her triple positive breast cancer. But it was not enough to rid her of the more aggressive and harder to treat form of the disease, so her oncologist recommended 14 rounds of Kadcyla, a chemotherapy drug used to target HER2-positive breast cancer that has spread to other parts of the body.

HER2 is a protein that makes breast cancer cells grow faster and breast cancer cells with higher than normal levels of the protein are called HER2-positive.

The treatment is not cheap. “My chemotherapy is $130,000 a pop because it’s very specialized,” Proffitt explained. The treatment increased Proffitt’s chances of survival by 87 percent over the next five years, and by 57 percent over the next 10 years, she said.

Three rounds of the treatment were approved in late September, but the full course of 14 rounds was initially denied, according to Proffitt and records reviewed by The Independent.

“They don’t care that I’m an employee,” said Proffitt, who works as a data program manager in the team that supports Aetna’s Medicaid customers.

“They don’t care that I’m a cancer patient. It would be cheaper for Aetna if I died,” a clearly frustrated Proffitt said.

Proffitt and her doctors appealed the decision and had to demonstrate why it was “medically necessary” that she continued treatment at the specialist New Orleans facility instead of moving to an alternative — and cheaper — clinic, she claimed.

“I’ve been fighting for my life for 11 months now,” Proffitt said. “To be told, ‘no,’ because it’s a bureaucratic money decision — I’m fighting to make it to 10 more years.”

Proffitt’s treatment was finally approved in full on Oct. 21, but the experience with the company that also pays her salary has left her worried for other patients.

“If this can happen to me, it can happen to anybody,” she said.

In a statement to The Independent, an Aetna spokesperson said the company acknowledged that navigating the healthcare system “can be deeply personal and, at times, challenging.”

“Each claim was carefully reviewed in accordance with established clinical standards,” the spokesperson said in response to Proffitt’s case. “The determinations were based on the plan’s benefits and applicable clinical guidelines. We collaborated closely with her healthcare provider, and after additional medical information was submitted, the claims were approved.”

“We recognize how complex healthcare decisions can be,” the spokesperson continued. “And we remain firmly committed to ensuring that every member – including our own employees – receives a fair, transparent, and clinically appropriate review of their care.”

‘I was not prepared to fight with insurance’

Like Proffitt, mom-of-four Amy Logan, of Muncie, Indiana, found herself exasperated after back-and-forths with her insurance provider, UnitedHealthcare, over critical treatments ordered by her oncologist.

“Is your plan for me to die?” she said she asked a UnitedHealthcare rep on the phone at one particularly low point. “Is that the solution? Because that’s what it feels like right now.”

At 40, she is already a survivor of cervical cancer. Then, in August 2024, doctors diagnosed her with inflammatory breast cancer, a rare and aggressive form of the disease. A single mastectomy, a trial of immunotherapy and a grueling course of chemotherapy followed.

She needed radiotherapy to finish off the disease. But the crucial treatment was initially denied after UnitedHealth questioned the number of sessions her doctors said she needed, at first deeming it not “medically necessary,” Logan said, showing The Independent paperwork to back up her claim.

“You hear all the time, ‘You have to fight for your life,’” Logan said of battling cancer. “And I expected to fight not feeling well.

“I expected to fight just having to get up and function and eat food when I didn’t want to — and fight to go to the doctor because I was exhausted,” she said.

“I wasn’t expecting to fight with insurance. That’s something you just aren’t prepared for, and a system that doesn’t feel designed to help you in any way.”

After appealing the decision, Logan was informed the radiation therapy was approved on Nov. 3 and she is now receiving the course recommended by specialists at the world-renowned University of Texas MD Anderson Cancer Center in Houston.

And while she is relieved with the outcome, Logan desperately wanted to be home this Thanksgiving with her husband, Joshua, and their four children, ages 4, 9, 17 and 20, but the delays to her treatment mean she will be 1,000 miles away in the hospital.

Delaying “is not really an option for me,” said Logan, who explained that even with all the treatments, there is still an approximate 35 percent chance the cancer will return within the next five years.

She teared up thinking about how much time the cancer has already robbed from her as a mother to her four kids.

“I’ve missed a year of birthdays,” she said. “Chemo itself is exhausting, the travel is exhausting — I don’t think I was able to experience my kids very well this year. I couldn’t go play, I couldn’t get out of bed. I’m just so ready to be done.”

Asked about Logan’s experience, a UnitedHealthcare spokesperson said the company “empathized” with anyone going through cancer.

“We empathize with anyone facing a cancer diagnosis and are committed to communicating coverage decisions clearly and promptly,” the spokesperson told The Independent. “Ms. Logan’s radiation treatment was approved under our policy, which is based on medical society guidelines including the National Comprehensive Cancer Network, American Society for Radiation Oncology and National Institute for Health and Care Excellence.”

“Her provider was offered a peer-to-peer review with one of our radiation oncologists to discuss her treatment plan in more detail,” the spokesperson added.

Both women ended up receiving the full course of treatment prescribed by their specialist medical teams, but said they had to jump through hoops to get it.

In addition, Logan and Proffitt both claimed they were saddled with additional bills in error, running into the thousands, which exacerbated their stress.

Proffitt said she is still in dispute with Aetna over a $4,000 bill for a white blood cell injection she required after chemotherapy, which she claimed was initially approved before her insurer pulled it from her coverage.

In response, Aetna said it was “reviewing any outstanding claims to ensure they are processed appropriately.”

Logan, meanwhile, had to contest a $53,000 bill she received — in a filing error. It was not clear whether UnitedHealthcare or the healthcare provider was at fault, but ultimately the error was corrected and she didn’t have to pay.

Doctors also frustrated: ‘It’s just a delay tactic’

It’s not just patients who are fed up with the insurance red tape — doctors find themselves spending a significant amount of time doing battle with health insurers over prior authorization on behalf of their patients.

Delays have consequences, especially when treating aggressive cancers, Dr Amar Rewari, chief of radiation oncology at Luminis Health, told The Independent.

“It is critical that cancer patients get their treatment in a timely manner,” said Rewari, who is also an adjunct professor at Johns Hopkins and on the board of directors for the American Society for Radiation Oncology (ASTRO). “Because the thing is, any delays can cause negative outcomes in terms of less likelihood for cure, as well as the treatment not working.”

Dr Shruti Patel, a clinical assistant professor at Stanford University and a gastrointestinal medical oncologist, agrees.

“The range of consequences goes from patients being anxious about getting started on treatment to progression of disease, where their cancer can go from curable to incurable,” said Patel.

Patel said there is no “blanket” rule for how quickly cancer patients must receive treatment, but the vast majority of tumors are fast-growing and time is of the essence.

“Getting started on treatment is imperative,” she said. “And when things are essentially delayed, you are potentially changing [a patient’s] outcome and making their cancer care journey worse.”

Rewari said that his Maryland clinic has had to hire additional staff to handle the mountain of administration that comes with prior authorization, which he has to submit for everything from initial PET and MRI scans to a course of radiation therapy.

“If I try to order a PET scan or an MRI, insurance companies will often fight me on it and say, ‘Oh, does this patient really need these expensive scans?’ And so they’ll sometimes deny it, which obviously causes a lot of stress for the patient,” he said.

“A lot of it is just purely delays, because they know that doctors are busy, and so they’re not going to have time to fight it,” said Rewari, who discusses insurance barriers to care and more on his healthcare podcast Value Health Voices.

Patel shared a story of a cancer patient whose care was particularly complex because she was also pregnant. Because of radiation risks to the fetus, the patient could not have a CT scan but required a PET scan and an MRI, which are more expensive.

“We really needed to get this done. I kind of thought, no matter what I would order that it would get approved, because this is such a rare case,” Patel said.

“They got denied,” Patel said, adding that she then spent hours on the phone trying to jump through numerous hoops with the insurer, who she did not identify.

More than 8 in 10 doctors said that the prior authorization burden is growing worse, reporting that it increased greatly (60 percent) or somewhat (25 percent) in the past three years, according to the 2024 ASTRO study.

Rewari attributes rising costs as one of the drivers behind the trend and said that, as a result, companies are relying on a process called utilization management — mechanisms insurance companies implement to control costs.

“They’re really investing heavily in that, which is, in other words, a way of reducing the expenses,” he said. “It’s just a delay tactic.”

‘Current system is complex and incredibly inefficient’

Dr Alexandra Zaleta, vice president of research and insights at the nonprofit CancerCare, oversaw a major study published this year about how cancer patients “get lost in the health insurance maze” while trying to cope with the disease.

The report found that 87 percent of patients on employer plans typically experienced prior authorizations more than those on Medicare Advantage (72 percent) and traditional Medicare plans (57 percent).

Zaleta said the current American health insurance system was incredibly complex and “inefficient” when it comes to cancer care.

“There’s a lot of dialogue right now about efficiency and waste,” Zaleta said. “And I struggle, looking at these data and at these stories, to understand how utilization management in cancer care is not an incredibly inefficient and potentially wasteful process, because it’s taking time and money from patients and families.”

Of the one in 10 patients who received a denial, 88 percent appealed the decision, CancerCare’s report found. Of these, 55 percent appealed once, 29 percent appealed twice, and 13 percent appealed three or more times. Nearly three out of four appeals eventually resulted in a decision reversal (72 percent), and 73 percent said the insurer fast-tracked the appeal due to the life-threatening nature of their cancer.

“Still, many respondents faced long waits for treatment because of the prior authorization process,” the report found. “Among those who appealed, one in three (33 percent) reported the entire approval process, including appeals, took one month or more.”

Advocacy groups are calling for urgent reform.

“There’s been an awareness of this problem for at least the last decade,” Zaleta said. “But whatever solutions or approaches are being implemented are not moving the needle.”

Individual states have taken action on prior authorization this year.

The American Society of Clinical Oncology tracked over 110 bills on the subject in 40 states during the 2025 legislative session, with many including calls to improve insurer response times and require companies to be more transparent about approvals, but federal reform has not yet been enacted into law.

For cancer patients, change can’t come soon enough.

“I try to stay optimistic but it is really hard,” said Logan . “How many delays can I go through?”