More than 80% of appealed Medicare Advantage prior authorization denials are overturned, yet fewer than 0.2% of ACA Marketplace denials are ever appealed. The problem is not only denial. It is a system that profits when patients run out of time, energy, and hope.

When an insurer labels trigeminal nerve blocks investigational, patients may face brain surgery instead. This essay examines how coverage policy, coding decisions, and actuarial incentives shape care for trigeminal neuralgia and what must change to align patient protection with economic logic.