It's not baffling because insurers are not dictating care. They only decide if they want to pay for it.

Doctors are free to give any care they want.

The problem is the doctors have a big financial incentive to do something. Whether it's useful or not is secondary. Likewise, the patients want to do something, it's a source of hope.

Remember the big flap about bone marrow transplants for advanced breast cancer? End result: a successful transplant meant you lived longer, but the risks of the transplant offset that, there was no survival advantage.

This is not to say that there are no improper denials. It's pretty obvious some companies use red tape, and I suspect some reviewers are either being held to unreasonable standards or being overworked, resulting in deliberately lost paperwork. (Remember the scandal with the VA dropping patient visits to make the numbers look better?)

And reading the article a few things stand out to me:

1) I can't find the name of the drug being denied.

2) She gives the stat that 49 million claims are denied but 0.2% were appealed--is that truly evidence of wrongdoing, or is it evidence of the insurance companies providing the no that doctors are afraid to give patients? And how many are entirely legitimate (my wife had a denial--right drug, right digits, wrong form, wrong dose. Clearly a human selected the wrong thing from a list)?

3) She talks about lives that would supposedly be saved by Medicare for All--never mind that that would collapse our system as there is considerable cost shifting from Medicare to those with commercial insurance.

n=1