Erin Massey spends her days as a scientist at a biotech firm. But lately, her free time has been consumed by a second, unpaid job: battling her health insurer, Cigna, for coverage of a doctor-prescribed insomnia medication.
Despite support from her physician and past approval by a previous insurer, Premera, Massey says Cigna repeatedly refused to cover the drug Quviviq, deemed medically necessary for her condition. For weeks, she has spent 8 to 10 hours weekly calling representatives, filing appeals, and navigating complex bureaucracy — an increasingly common experience for Americans entangled in the web of insurance claim denials.
Her case is one among millions. A Gallup poll estimates Americans spend over 12 million hours per week dealing with health insurers. According to a 2024 Commonwealth Fund study, 17% of working-age adults were denied coverage for doctor-recommended care in the past year, and 45% received surprise bills for services they believed were covered.
These time-consuming hurdles — often labeled a “time tax” or bureaucratic “sludge” — can lead to care delays, financial stress, and diminished trust in the healthcare system. For Massey, the frustration was magnified by the fact that she had spent eight years searching for an effective treatment. “It’s demoralizing,” she said, describing the emotional toll of facing roadblocks after finally finding a solution.
After TIME reached out to Cigna for comment, the insurer reversed its decision, notifying Massey that her medication would be covered. In a statement, Cigna said it aims to reduce administrative burdens and recently launched initiatives to streamline customer service. “We don’t want anyone spending hours on the phone,” the company stated.
But critics say such reversals only happen under public scrutiny. Stanford professor Jeffrey Pfeffer estimates that the time lost by workers battling with insurers costs the U.S. economy $21.6 billion annually in productivity — with broader workplace impacts including burnout and dissatisfaction. Pfeffer believes employers must hold insurers accountable. “Your employer hires your insurance company,” he said. “They should enforce performance standards and fire insurers who don’t meet them.”
With few regulatory safeguards in place, many patients are left to fight alone. Massey, who nearly filed an external appeal before Cigna relented, has now become well-versed in the appeals process. “I don’t end a call without getting everything in writing,” she said.
Her story underscores a growing issue in American healthcare: even with insurance, access to care is not guaranteed — and the cost of bureaucracy can be measured in both dollars and time.
