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, on top of having cancer,” said Hsu, who filed a complaint against her insurer over the denial.
Ultimately, Hsu's employer ended up paying for the PET scan out of pocket.
That scan saved her life.
It showed that the cancer had spread to her liver. “If I had not had the PET scan, I would not have known my cancer had spread. I could have died,” Hsu said.
Hsu had surgery to remove the tumor in her liver and continues to be monitored closely by her doctor.
In 2025, Hsu’s employer switched to a new insurance company.
Hsu’s experience is not an anomaly — it’s a part of a growing problem where cancer patients are being denied medically necessary testing.
In 2026, there will be an estimated 2.1 million new cancer cases. Getting the right diagnostic testing is crucial to creating a comprehensive treatment plan specific to each patient’s needs, and denying these tests causes harm to people whose health depends on early tumor detection and access to specialized care.
Yet, denial rates for imaging continue to rise.
A study published in JAMA Network found that 22% of cancer patients did not receive the care recommended by their healthcare team as the result of insurance denials and delays.
Another study, published in the Journal of Surgical Research, found that 13.1% of cancer patients received initial denials for imaging, more than half of which were eventually overturned.
PET scans are among the hardest tests to get approved
Research shows that PET scans are significantly more accurate (86%–90%) than other types of imaging because of their ability to analyze metabolic activity in tumors.
That means PET scans are a crucial diagnostic tool for assessing breast and gynecologic cancers — and using a PET and CT scan together represents a “significant advancement in personalized medicine” and the ability to tailor treatment to each patient's diagnosis.
“PET scans are absolutely the gold standard for determining what stage certain cancers are in,” said Julie Gralow, M.D., the Chief medical officer for the American Society of Clinical Oncology.
In spite of their importance, insurers deny PET scans up to 60% of the time for chronic medical conditions due to their high cost, claiming the scans are “not medically necessary” or “experimental,” even though PET scans have been used for decades and have transformed cancer care by improving detection, treatment planning and assessing treatment response.
Prior authorizations create delays in patient care
AHIP, the national trade association representing the health insurance industry, claims that prior authorizations — when an insurance company reviews a request for medical services to determine if they will pay for it — are a necessary safeguard that keeps out-of-pocket costs and premiums down.
But medical experts report that prior authorization requirements have created significant barriers in getting imaging approved for cancer patients and delays care, which can lead to negative outcomes, including disease progression and even death.
Gralow said that obtaining prior approval for imaging used to be a way for insurers to weed out unnecessary or unproven testing, but things have changed, and now medically necessary imaging is being denied.
“This is no longer about ensuring that we are using evidence-based care,” Gralow noted.
Elena Ratner, M.D., a gynecologic oncologist at Yale Cancer Center, agrees.
Ratner said that prior authorization requirements have also impacted staffing.
“Medical facilities have had to hire staff just to deal with getting prior authorizations approved. It takes a lot of manpower to get these scans authorized. There is a real risk of harm to patients when PET scans are denied. In my 25 years of practice, we have never been in this kind of predicament in healthcare,” Ratner said.
Patients have the right to appeal imaging denials
Scott Glovsky, an attorney in California who represents cancer patients who have been denied imaging by their insurers, said that while getting approval for imaging has gotten harder, it’s important for patients to know what their options are if they receive a denial.
Glovsky believes that insurers frequently prioritize profit over patients. “To insurance companies, time is money, and if they can deny or delay treatment for terminally ill patients, then they may never have to pay for that treatment,” Glovsky said.
Glovsky recommends patients file an expedited appeal immediately after receiving the first denial.
“Time is critical with cancer patients — never take the first no for an answer,” Glovsky added.
During the appeal process, doctors can also request a peer-to-peer review, which is a clinical discussion between a medical provider and the insurance company to establish why a service is medically necessary.
Under the Affordable Care Act, patients also have the right to submit a request for an external review (an independent third-party medical professional reviews the denial) for services that were denied due to the insurer claiming they were not medically necessary.
Many are not aware of their appeal rights
In a 2023 national survey of adults with health insurance, almost 7 out of 10 respondents didn’t know they could appeal denied claims. And, according to KFF, only 4% of patients enrolled in a marketplace insurance plan pursued an external review in 2024 — but when they’re requested, many denials are overturned.
Patients can also seek assistance from Consumer Assistance Programs (CAP) — typically nonprofit agencies or independent state ombudsman offices — that assist patients with insurance issues, including claim denials.
People living in states without a CAP program can contact the National Patient Advocate Foundation for assistance.
If patients have concerns that insurers are not following required protocol (they didn’t provide patients with a written copy of their denial, or exceeded the legally permitted time frame to review an authorization request, and so on), they can file a grievance with their insurer and also contact their state department of insurance to file a complaint.
Imaging denials are more than an inconvenience
As Hsu reflects on her battle to get critical imaging approved, being denied PET scans continues to haunt her. Whenever her current oncologist submits the prior authorization request, she’s concerned that she could be put through this ordeal again.
“Every time I get a letter from the insurance company, I get so much anxiety — it’s really given me this terror on top of the cancer,” Hsu added.
Denying people access to medically necessary tests can cause them anxiety that can significantly impact their health. But more than that, making decisions based on profits over people can compromise patients’ abilities to receive an accurate diagnosis and treatment for life-threatening conditions — and that can have deadly consequences.
