85% of Cancer Patients Face Unnecessary Insurance "Red Tape" Due to Prior Authorization, Says New CancerCare Report

National survey of 1,201 adults with cancer shows administrative barriers that delay diagnosis and treatment, calling for urgent policy reforms.

NEW YORK, June 10, 2025 /PRNewswire/ -- CancerCare today released The Health Insurance Maze: How Cancer Patients Get Lost in the Red Tape of Utilization Management, a first-of-its-kind national survey that exposes how prior authorization requirements and coverage stoppages create serious barriers to life–saving cancer care. 

Of the 1,201 people with cancer surveyed, 85% had their insurance companies require prior authorization before receiving a doctor-prescribed cancer treatment, 76% in the last year alone. This introduced significant time burdens, stress, and delays at a time when people were dealing with serious illness. 29% of all respondents experienced diagnostic delays due to their most recent authorization, and 40% had treatment delayed because of this red tape, despite 95% of authorization requests eventually being approved, highlighting the inefficient use of utilization management in cancer. 

"For people with cancer, delays and denials caused by utilization management can mean the difference between life and death," said Christine Verini, CEO of CancerCare. "Our research exposes how these practices impact patients, because behind every policy is a person fighting for their life. The results in this report shed light on the true costs of utilization management—and are critical to challenging systems that stand in the way of timely, lifesaving care."

Other key findings include: 

• Red tape differed across insurance types: 87% of those surveyed with employer–sponsored plans faced prior authorization in the last year, compared to 72% with Medicare Advantage and 57% with Traditional Medicare. 

• When patients or families got directly involved in authorizations, they lost significant time: 51% lost up to a full business day, 27% lost up to 2-3 business days, and 12% lost a full business week or more to dealing with a single authorization request. 

• Coverage stoppages affected 18% of patients ever and 14% within the past year; appeals reversed 72% of stoppages, but 20% of those with stoppages were told they had to use alternate therapies. 

• Problems with insurance led to negative impacts on people with cancer: 36% of respondents reported worsened stress, 34% worsened finances, and 29% worsened trust in the healthcare system 

Utilization management tools like prior authorization are intended to verify medical necessity, yet in cancer care, they frequently delay diagnosis and treatment, introducing "time toxicity" that drains patients, caregivers, and even employers of precious hours. Although 95% of approvals occur eventually, the process siphons off days that patients could be spending on healing, and it amplifies financial and emotional burdens. 

"Our findings make clear that utilization management policies—while intended to manage costs—often create dangerous delays and stress for people fighting cancer. And in most cases, people who get insurance from their employer faced the greatest barriers," said Dr. Alexandra Zaleta, lead author and Associate Vice President of Research and Insights at CancerCare. "Policymakers and insurers must streamline these processes so patients can focus on treatment, not red tape." 

Download the full report at https://www.cancercare.org/redtape to learn more about the insurance challenges facing people with cancer and to join our call for reforms to protect patients from unnecessary administrative hurdles. 

Report Background 

Between September and December 2024, CancerCare's online survey screened 47,225 U.S. adults to identify 1,201 individuals who had received cancer treatment in the prior year and met other eligibility including insurance type. Participants represented employer–sponsored plans (n=569), Medicare Advantage (n=408), and Traditional Medicare (n=224). 

About CancerCare® 

For over 80 years, CancerCare has empowered millions of people affected by cancer through free counseling, resource navigation, support groups, educational resources, advocacy, and direct financial assistance. Our oncology social workers improve the lives of people diagnosed with cancer, caregivers, survivors, and the bereaved, by addressing their emotional, practical, and financial challenges. To learn more, visit www.cancercare.org. 

CONTACT: 

Amanda Shlosberg
Senior Director of Communications, CancerCare 

Phone: (212) 712–8323

Email: [email protected]

SOURCE CancerCare