2023 Education Series: What are the Causes of Contract Invisibility?

Health insurers love to advertise themselves as guardians of care, but the real story often begins when a patient’s life no longer fits neatly into a spreadsheet. In oncology especially, “coverage” isn’t a bureaucratic checkbox—it’s the fragile bridge between a treatment that finally works and a relapse that can undo years of grit…

In “Fighting for Coverage,” a patient describes a double war: the physical fight to stay alive and the bureaucratic fight to prove to an insurer that her life is worth the cost. Her account spotlights a core tension in the U.S. system—coverage decisions are increasingly shaped by prior authorizations and desk-based reviewers who…

The sustainability of the healthcare system won’t be secured by another round of cost-cutting or clever benefit design alone, but by a hard cultural pivot toward alignment: payers, providers, employers, and patient advocates pulling on the same rope instead of grading each other on different exams. Right now we’ve built a maze that…