Virginia woman says her insurer denied her a critical scan two years ago — now she’s fighting stage 4 lung cancer

Despite having the highest wellness spending successful the industrialized world, the U.S. has immoderate of the worst wellness outcomes (1).

A 2025 study from the Peterson Center connected Healthcare (2) and KFF (3) projected that Americans would walk $5.6 trillion connected wellness attraction (4) for the twelvemonth — and that fig is expected to proceed increasing to a imaginable $8.6 trillion by 2033. Yet the precocious outgo of care, delays successful attraction and fragmented security sum person near galore patients crossed the state vulnerable.

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Rebecca Payette is simply a premier example. In an interrogation with WCVB (5), the Virginia pistillate says she's present battling signifier 4 crab aft her security denied a captious PET scan.

Payette began experiencing changeless fatigue astir 2 years ago, but doctors initially thought it was COVID-19 contempt her ne'er investigating positive. In 2024, she says a spot was recovered connected her lung during an yearly checkup. Her doc suggested a scan.

"So, helium fixed it up, enactment it astatine the extremity of the referral, got to my paperwork and was expected to spell for the scan. The security institution denied it," Payette said. She noted that she was told the lesion successful her lung wasn’t large enough.

Since nary 1 seemed excessively disquieted astir it, Payette fto it go.

It wasn't until a twelvemonth later, erstwhile different doc approved the scan, that everything changed. She was diagnosed with Stage IV metastatic adenocarcinoma (6), an assertive signifier of lung cancer. Without treatment, doctors told her she apt had conscionable 2 years to live.

"I consciousness similar they signed my decease certificate; I truly did," Rebecca Payette said.

Payette present makes a astir two-hour thrust each week, from Virginia to North Carolina, for treatment.

The denial rates

The astir caller information connected wellness attraction (7) rejections recovered that successful 2023, wellness security speech carriers rejected astir one-in-five in-network claims. Out-of-network claims were denied astatine 37%.

The survey besides recovered denial rates differed based connected coverage. People with marketplace security reported higher rates of denial, compared to individuals with Medicare oregon Medicaid.

The crushed claims are rejected varies. Denials tin hap erstwhile patients person reached their payment limits, if a process is excluded from sum oregon if it's seen arsenic investigational oregon experimental.