Why Does Insurance Deny Life-Saving Treatments?
Insurance companies operate on a simple principle: minimize costs. They decide which treatments are “medically necessary” based on outdated policies, bureaucratic loopholes, and profit-driven motives. Here are the most common reasons claims get denied:
- “Experimental” Label — Even FDA-approved treatments like gene therapy or CAR-T cell therapy can be denied if insurers classify them as experimental.
- High Cost — Cutting-edge treatments, like sickle cell gene therapy ($2 million+), are rejected because of their price.
- Step Therapy Requirements — Some policies force patients to try and fail older, less effective treatments before approving advanced care.
- Out-of-Network Providers — If a hospital or specialist isn’t in-network, coverage can be denied outright.
- Medical Necessity Debate — Insurers may argue that a treatment isn’t essential, even when doctors insist it’s life-saving.
