The Cost of Saying No: When Insurers Deny Critical Imaging Tests, Cancer Treatment Is Delayed

September is Gynecologic Cancer Awareness Month.After Kay Hsu was diagnosed with advanced, stage 4 breast cancer in 2018, she had a PET scan — an imaging test that can detect and analyze tumors — every four months. For six years, these scans were a routine part of her care and were covered by her health insurance.But in September 2024, things changed.Hsu’s insurer denied her PET scan, claiming it was “not medically necessary.”“I was so upset that I could hardly see straight,” Hsu recalled. “I had never been denied a PET scan. I have stage 4 breast cancer, which is incurable, and scans every four months are the standard recommendation from my specialist.”Hsu, an advertising creative director in New York City, said that despite paying her premium and copays — everything she is supposed to do to maintain her coverage — she was still denied essential care.Hsu’s doctor submitted an appeal to Hsu's insurer, Cigna Healthcare, but they upheld the denial. Despite Hsu's advanced cancer diagnosis, both denial letters stated that "the service requested is not medically necessary."“The realization that this private company can have so much power over whether you live or die — it’s a huge burden...