May 20, 2026
Despite having the highest health spending in the industrialized world, the U.S. has some of the worst health outcomes (1).
A 2025 report from the Peterson Center on Healthcare (2) and KFF (3) projected that Americans would spend $5.6 trillion on health care (4) for the year — and that number is expected to continue growing to a possible $8.6 trillion by 2033. Yet the high cost of care, delays in treatment and fragmented insurance coverage have left many patients across the country vulnerable.
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Rebecca Payette is a prime example. In an interview with WCVB (5), the Virginia woman says she's now battling stage 4 cancer after her insurance denied a critical PET scan.
Payette began experiencing constant fatigue nearly two years ago, but doctors initially thought it was COVID-19 despite her never testing positive. In 2024, she says a spot was found on her lung during an annual checkup. Her doctor suggested a scan.
"So, he fixed it up, put it at the end of the referral, got to my paperwork and was supposed to go for the scan. The insurance company denied it," Payette said. She noted that she was told the lesion in her lung wasn’t big enough.
Since no one seemed too worried about it, Payette let it go.
It wasn't until a year later, when another doctor approved the scan, that everything changed. She was diagnosed with Stage IV metastatic adenocarcinoma (6), an aggressive form of lung cancer. Without treatment, doctors told her she likely had just two years to live.
"I feel like they signed my death certificate; I really did," Rebecca Payette said.
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Payette now makes a nearly two-hour drive every week, from Virginia to North Carolina, for treatment.
The denial rates
The most recent data on health care (7) rejections found that in 2023, health insurance exchange carriers rejected nearly one-in-five in-network claims. Out-of-network claims were denied at 37%.
The study also found denial rates differed based on coverage. People with marketplace insurance reported higher rates of denial, compared to individuals with Medicare or Medicaid.
The reason claims are rejected varies. Denials can happen when patients have reached their benefit limits, if a procedure is excluded from coverage or if it's seen as investigational or experimental.
Oftentimes doctors are also required to perform "peer to peer" reviews (8), where they have to justify treatments to insurance companies. This can present challenges when health insurance representatives are inexperienced or unfamiliar with treatment options, or when they attempt to apply standardized criteria to individual cases.
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When insurance companies deny claims, the consequences can be severe — and not just for your health. Denied claims mean patients can be left paying out of pocket, with the median bill running roughly $630 per service (9).
And lower-income Americans are already facing the brunt of denials. A 2024 study found patients making $30,000 or less a year per household were 43% (10) more likely to have preventative care claims denied than higher-income people.
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What to do if you're rejected
Having your insurance claim rejected can be stressful, scary and confusing. In cases like Payette's, delays in testing can be life altering.
If your claim is denied, you have the right to appeal the decision (11). You may ask your insurance company to conduct a review of the decision. You also have the right to appeal the decision to a third party for external review.
Before filing your appeal, you should understand why you were rejected and gather evidence showing your policy and denial record. If your appeal is unsuccessful, you can file a complaint with your state insurance commissioner (12).
Having an emergency savings fund can also help protect you when coverage is denied. Medical bills are a leading cause of bankruptcy (13) for people in the U.S., and with the rise in denial rates, having money set aside can help protect your finances and ensure vital treatment isn't being delayed.
Article Sources
We rely only on vetted sources and credible third-party reporting. For details, see our ethics and guidelines.
The Commonwealth Fund (1); Peterson Center on Healthcare (2); KFF (3),(7); Peterson-KFF Health System Tracker (4); WCVB (5); Cleveland Clinic (6); STAT News (8); National Institutes of Health (9); Think Global Health (10); HealthCare.gov (11); American College of Rheumatology (12); American Bankruptcy Institute (13)
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Rinna Diamantakos is an assigning editor at Moneywise.com. A versatile journalist, she has experience as a writer, editor and producer. Her work has focused on politics, business and financial news.
