https://www.propublica.org/article/cigna-pxdx-medical-health...
https://www.propublica.org/article/evicore-health-insurance-...
This is one example of how hard it can be to fight these fraudulent denials, even for someone with above average resources:
https://www.propublica.org/article/priority-health-michigan-...
Individuals can’t fix these problems at scale: it needs something like a government investigator with subpoena power and the ability to directly fine executives. As long as people make more money by denying care, they’re just going to keep finding ways to do so.
Certain expensive chemo drugs will get denied unless cheaper options are tried first, if they're used off-label or experimental. Some won't be approved until surgery, at too early a stage or if tests don't indicate elevated risk factors.
How does that happen? AFAIK the ACA mandates coverage for cancer treatment for almost all plans.