"Medically Necessary" Is Killing People
How two words became a profit engine - and how USC makes your doctor's judgment the default
Eric Tennant was 58 years old. He had stage 4 bile duct cancer.
His doctor recommended a procedure called histotripsy in February 2025. UnitedHealthcare denied it. “Not medically necessary,” they said.
Eric died on September 17, 2025, in a hospice bed at his West Virginia home.
The Man Who Ran Out of Time
Eric Tennant spent his career as a safety instructor - teaching people how to avoid harm. When cancer spread to his liver and bones, his oncologist identified a promising treatment: histotripsy, a non-invasive procedure that uses sound waves to destroy tumors.
UnitedHealthcare said no.
Eric and his wife Becky appealed. Denied again in March. They kept fighting. Months passed. The cancer didn’t wait.
Then something remarkable happened. Journalists from KFF Health News and NBC News contacted UnitedHealthcare about Eric’s case. Suddenly, the insurer reversed course and approved the procedure.
Here’s the part that should make your blood boil: UnitedHealthcare told the reporters before they told the family.
By then it was May. Eric was hospitalized. The medications keeping him alive made the procedure impossible. The approval came. It was worthless.
“Any lawyer for the insurance will say, ‘Well, you don’t know it would have helped,’” Becky Tennant told reporters after her husband’s death. “No. You took that chance away from us.”
You can read the full investigation into Eric’s story from KFF Health News and NBC News here.
The Business Model
UnitedHealth Group - Eric’s insurer - reported $2.3 billion in profit in Q3 2025 alone.
Their CEO, Andrew Witty, made $23.5 million in 2024. That’s roughly $64,000 per day.
Eric Tennant didn’t make it 60 days after his final denial.
This isn’t a bug in the system. It’s the business model. Insurance companies profit when claims get denied. “Medically necessary” has become the two most profitable words in American healthcare - because insurers get to decide what it means.
The American Medical Association surveyed physicians in December 2024. The findings:
29% of physicians report prior authorization caused a serious adverse event for a patient
8% report prior authorization contributed to a patient’s disability, permanent bodily damage, or death
82% say prior authorization leads patients to abandon recommended treatment entirely
And here’s the number that reveals the whole game: fewer than 1% of denied claims are appealed. But when patients do appeal? 80% win.
The denials aren’t based on medical judgment. They’re based on the bet that you won’t fight back.
It’s Not Just One Story
Eric Tennant isn’t an outlier. He’s a pattern.
Kathleen Valentini was 47 when she developed hip pain. Her doctor ordered an MRI. Her insurer, through a company called eviCore, denied it - said she needed six more weeks of physical therapy first.
She had already completed physical therapy. eviCore didn’t notice.
The denial was reversed after 40 days. The MRI revealed a sarcoma in her hip. Doctors at Memorial Sloan Kettering delivered the news: “Had you come to us a month sooner, we could have used chemotherapy. Now we can’t; we have to amputate before we treat with chemo.”
Kathleen lost her leg, her hip, and her pelvis. The cancer spread to her lungs. She died.
Her family sued. The court dismissed the case. The insurer, the judge ruled, had “no duty of care.”
You can read the full story of Kathleen’s case and the AMA’s response here.
Amanda Boley was walking her dog in Indiana when she collapsed from cardiac arrest on October 24, 2024. Her heart stopped. Paramedics revived her and called for an emergency helicopter - the only way to get her to a hospital that could save her life.
She survived. Then Anthem Blue Cross Blue Shield denied the $64,998 helicopter bill.
The reason? She didn’t get “pre-approval” for the flight.
“That night I was dead and then I was unconscious,” Boley told reporters. “I don’t know how I’m supposed to get pre-approval.”
Anthem reversed the denial only after journalists contacted them. They admitted error and apologized.
You can read the full story of Amanda’s $65,000 helicopter bill here.
Who Decides What “Necessary” Means?
Right now, insurance companies decide. With no consistent standards. No transparency. No accountability.
Your doctor completes four years of medical school, three to seven years of residency, passes board certification, examines you, reviews your history, orders tests, and recommends treatment.
A claims processor with no medical degree and a quota to meet can override that judgment by checking a box.
This is the mechanism that killed Eric Tennant. That cost Kathleen Valentini her leg and then her life. That billed Amanda Boley $65,000 for the helicopter that saved her while she was clinically dead.
“Medically necessary” doesn’t mean what your doctor says you need. It means whatever the insurance company’s algorithm approves.
What USC Changes
Universal Standard Coverage doesn’t just expand who’s covered. It rewires how “medically necessary” works.
The fundamental shift: Your doctor’s judgment isn’t a request to be approved or denied. It’s the default.
Here’s how:
Published standards, not insurer discretion. Under USC, “medically necessary” is defined by an independent Rate and Coverage Commission using published clinical guidelines and transparent evidence reviews - not by whatever interpretation maximizes quarterly profits.
Care proceeds. Disputes happen later. For urgent or time-sensitive care, the treating clinician’s judgment governs. Care happens first. Payment disputes are resolved outside the clinical encounter, without the patient caught in the middle.
No prior authorization gatekeeping. USC eliminates routine prior authorization. For services within published clinical pathways, claims process automatically. When review is required for genuinely novel interventions, it’s governed by published criteria, rapid timelines, and documented rationale.
You’re never financially exposed during a dispute. If a coverage question arises, you are not held responsible while it’s resolved. USC’s administrative process cannot recreate billing-tail shock through disputed-service cascades.
The burden shifts. You don’t have to prove you deserve care. The system has to prove you don’t.
The Choice
We can keep a system where insurance executives make $64,000 per day while patients die waiting for approval their doctors already gave.
Or we can build a system where “medically necessary” means what it says - defined by evidence, determined by clinicians, delivered without fear.
Becky Tennant will never know if histotripsy would have saved her husband. UnitedHealthcare took that chance away.
How many more chances are we willing to let them take?
Share this with someone who’s had a claim denied. Or someone who’s delayed care because they couldn’t predict what their insurer would approve.
That’s most of us.
This is Part 5 of the Universal Standard Coverage series.
Part 1: America doesn’t have a healthcare system - it has a healthcare catastrophe
Part 2: The evidence: Why $5.3 trillion buys administrative chaos
Part 3: Why incremental fixes can’t solve structural failures
Part 4: The architecture of a system designed to work
Coming next: Who decides what’s covered - and how to keep them honest. The governance model that makes USC incorruptible.
Sources:
Eric Tennant: KFF Health News and NBC News, November 2025
Kathleen Valentini: Court records, AMA amicus brief, January 2026
Amanda Boley: WTHR Indianapolis, JEMS, Today.com, February-March 2025
Physician survey data: American Medical Association, December 2024
UnitedHealth executive compensation: Company filings, 2024