How Insurance Red Tape Threatens Timely Cancer Care

Prior authorization requirements like coverage stoppages and other red tape can generate barriers to life saving therapies in cancer care.

For patients with cancer, prior authorization requirements and coverage stoppages generate barriers to life saving therapies and care, according to a first-of-its-kind national survey entitled “The Health Insurance Maze: How Cancer Patients Get Lost in the Red Tape of Utilization Management” from CancerCare.

In total, 1,201 patients with cancer were surveyed, revealing unnecessary insurance “red tape”. Insurance companies required 85% of the patients surveyed to receive prior authorization before receiving a doctor-prescribed cancer treatment, 76% of which were in the last year alone. These delays can cause significant time burdens and stress for these patients, during a time when they are already delay with a serious illness.

“For people with cancer, delays and denials caused by utilization management can mean the difference between life and death,” Christine Verini, CEO of CancerCare, stated in a press release detailing their research. “Our research exposes how these practices impact patients, because behind every policy is a person fighting for their life. The results in this report shed light on the true costs of utilization management — and are critical to challenging systems that stand in the way of timely, lifesaving care.”

Moreover, 29% of the patients surveyed experienced diagnostic delays due to these authorizations and 40% experienced treatment delays. These delays occurred even though 95% of authorization requests eventually being approved, shining a light on the inefficient use of utilization management in cancer, according to the research.

Prior authorization is one of many utilization management (a set of insurance practices used to control costs by managing when, how, and whether certain treatments are approved) tools used by insurance companies with the intention to verify a medical necessity for care. However, in cancer care, these authorizations frequently — as demonstrated in the study — cause delays in diagnosis and treatment, also referred to as 'time toxicity'.

Time toxicity, as defined by ScienceDirect.com, is a concept which is intended to describe the cumulative burden of time spent on treatment-related activities by patients with cancer, characterized by disruption of daily life, but in this instance, it is the delay in of actual treatment that cause the time toxicity for patients. These delays drain patients, caregivers, and employers of precious, sometimes lifesaving, hours, according to the release. The days that the process takes are days that patients could have spent delving into their treatment plans, but instead is now a time that is characterized by financial and emotional burdens.

“Our findings make clear that utilization management policies — while intended to manage costs — often create dangerous delays and stress for people fighting cancer. And in most cases, people who get insurance from their employer faced the greatest barriers,” Dr. Alexandra Zaleta, lead study author and associate vice president of Research and Insights at CancerCare, stated. “Policymakers and insurers must streamline these processes so patients can focus on treatment, not red tape.”

More Information on the Study at Hand

Between September and December of 2024, the online survey screened 47,225 adults in the U.S. to identify 1,201 patients who had received cancer treatment over the past year, as well as met other eligibility criteria. Patients on who participated in the survey had insurance types spanning employer sponsored plans (569 patients), Medicare Advantage (408 patients) and Traditional Medicare (224 patients).

Investigators went on to share of their findings that the red tape caused by current utilization management policies across insurance types. For example, although 87% of participants surveyed with employer sponsored insurance plans experience prior authorization in the last year, this number was 72% with Medicare Advantage and 57% with Traditional Medicare.

Moreover, significant time was lost when patients or their families became directly involved in managing prior authorization requests. In total, 51% of participants lost up to a full business day when addressing a single authorization, while 27% lost up to two to three business days, and 12% lost an entire business week or more. Additionally, 18% of respondents experienced coverage stoppages at some point, with 14% encountering them within the past year. Although, 72% of appeals were successful in reversing these stoppages, 20% of those affected were instructed to pursue alternate therapies and stop their originally prescribed treatments.

Problems with insurance contributed to a range of impacts on the patients with cancer. For example, 36% of surveyors reported increased stress, 34% experienced worsened finances, and 29% indicated that their trust in the healthcare system had been diminished.

“The results of this report make it clear that many people with cancer face insurance red tape and administrative inefficiencies that obstruct access to timely, high-quality care,” investigators emphasized. “Utilization management and other cost-containment strategies must be designed to support, not delay or deny, affordable cancer treatment. Reforming these systems is essential to reducing burden in patients, improving outcomes, and ensuring that administrative processes facilitate, rather than hinder, care. Policymakers, insurers, employers, and advocates must collaborate to streamline utilization management processes, increase transparency, and prioritize person-centered care, allowing patients to focus on recovery, not red tape.”

Reference:

“The Health Insurance Maze: How Cancer Patients Get Lost in the Red Tape of Utilization Management” by CancerCare. 2025 Red Tape Report by CancerCare.

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