Verified cases & the Harm Bridge
Three scenarios journalists can quote without editing — each number linked to a primary source — plus an interactive tool that connects a plan's own published delay to a peer-reviewed mortality risk estimate.
The Harm Bridge
Pick a cancer indication and a reporting plan. The delay auto-fills from the plan's published median decision time; the engine applies the Hanna et al. hazard ratio and shows the 95% confidence interval.
- Payer / operational source
- Mortality science source
- Framing
- Population-level association estimate — not individual causation, not medical advice. Full methodology.
The National Baseline
What does the typical insurer delay look like when mapped onto head & neck radiation oncology — the specialty where ASTRO surveys document the heaviest prior-auth burden?
| Operational input | AuthDenied pooled median standard PA decision time: 2.9 days across 1,208 CMS-0057-F reporting plans (CY2025) |
|---|---|
| Science input | Head & neck — radical radiotherapy: HR 1.09 per 4 weeks (95% CI 1.05–1.14) — Hanna et al., BMJ 2020 |
| Formula | RR = 1.09(2.9/28) → excess risk = (RR − 1) × 100% |
Sources: AuthDenied national aggregate · Hanna BMJ 2020 (doi:10.1136/bmj.m4087) · ASTRO 2024 PA survey
High-Denial vs Low-Denial Parent — Same Science, Different Operations
UnitedHealth Group and Humana report very different prior-auth denial rates on their own CMS-0057-F filings. Using the same breast-cancer surgery hazard ratio, how does each parent's published median turnaround translate into estimated excess mortality risk?
| Science input | Breast cancer — surgery: HR 1.08 per 4 weeks (95% CI 1.03–1.13) — Hanna et al., BMJ 2020 |
|---|---|
| UnitedHealth Group | |
| Humana Inc. |
Sources: AuthDenied — UnitedHealth Group · AuthDenied — Humana · Hanna BMJ 2020
Illustrative / unverified plan figure. The per-company median turnaround values are illustrative figures derived from self-reported CMS-0057-F disclosures and have not been independently verified. Each percentage is an estimated relative increase in mortality risk from applying a published hazard ratio to that delay — an operational comparison on insurers' own published metrics, not a claim that either company caused any specific death.
When Appeals Prove the First Denial Was Wrong — The Harm Happens in the Waiting
Government watchdogs and KFF both document that a large share of appealed prior-auth denials are overturned — meaning patients waited through a denial that was later reversed. Model the mortality risk association during a 7-day appeal window (CMS standard PA deadline) for colon cancer surgery.
| Operational facts | HHS-OIG: 95% of appealed SNF-admission denials overturned (Jun 2024 sample, 19 MAOs). KFF: 80.7% of MA appealed denials overturned CY2024. |
|---|---|
| Delay modeled | 7 days — CMS standard prior-auth decision window for non-expedited requests (effective Jan 1, 2026) |
| Science input | Colon cancer — surgery (colectomy): HR 1.06 per 4 weeks (95% CI 1.01–1.12) — Hanna et al., BMJ 2020 |
Sources: HHS-OIG OEI-09-24-00331 · KFF MA PA analysis CY2024 · CMS-0057-F fact sheet · Hanna BMJ 2020