Behind oncology's RCM challenges: Real patient stories

The view from the waiting room

There are things you cannot learn from training, a textbook, or even years of professional experience. Some knowledge arrives only one way — through proximity to real people, in real moments, navigating systems that may not have been fully built with them in mind.

This is the case with cancer. A diagnosis doesn’t arrive alone — it comes with a swirl of uncertainty. It brings with it a fear, uncertainty, and an immediate, desperate need to understand one’s options, odds, and to find answers. There is no clear path ahead, only the terrifying work of finding one. The last thing anyone navigating that should face is an administrative system that makes getting to care harder than it already is.

We work in that infrastructure. We’ve spent our careers building technology for oncology organizations, and we believe in what good technology can do. But our conviction is earned: it didn't start with feature sets and software updates; it started somewhere much closer to the thing itself — personal experience with real cancer patients undergoing care.

Both of us came back to the same place of understanding: the administrative experience of cancer care is inextricably connected to the care experience itself. For patients already carrying a diagnosis, there is almost no separating the two.

As cancer treatment grows more complex, so too does the administrative infrastructure required to support it. AI and intelligent technology have a real and urgent role to play — automating what can be automated, surfacing what would otherwise be missed, continuously improving the systems that stand between a patient and their care. A more optimized process is exactly the goal, because when the administrative burden lifts, staff can be fully present, and patients and caregivers can focus on what actually matters.

We know this because we've lived this. We’ve chosen to work in revenue cycle management in healthcare because we know firsthand that it makes a tangible impact.

Alyssa

Early in my career, I traveled to Texas to help lead a working session for a large oncology organization – I was there to teach, support, and help streamline their processes.

From the front desk, I watched the line grow each morning. Patients arrived already carrying the weight of a diagnosis — some with a family member beside them, many alone. And before any of them could receive a single minute of care, each one had to move through dozens of manual steps: coverage verification, financial counseling, scheduling, check-in. The phones rang constantly. The line didn't  stop.

The staff were doing two jobs simultaneously: managing a relentless administrative process and trying to be present for people in one of the hardest moments of their lives. Our complex healthcare ecosystem demanded the first — but their patients needed the second. In the end, it felt like there was never enough of either.

Day after day, I saw the same faces return for infusion. I came to know their rhythms — who came with a spouse, who came alone, who seemed a little more tired than the week before. Then one day, a patient came back without the person who had always been beside them. The staff noticed; they felt it. And then the phone rang, and the next patient was at the window, and the moment passed — because there were still dozens of steps standing between that staff member and the next patient's care, and the system wasn't going to wait.

That's when I understood what broken administrative infrastructure actually takes from oncology providers: their presence.

Carrie

I lost my father to liver cancer in 2020. From the moment a biopsy returns a result, a patient can wait anywhere from three weeks to four months before they are seen by the oncologist who will guide their care. In that window, the cancer doesn't pause. Neither does the fear.

I watched my father navigate that — the waiting, the uncertainty, the system’s indifference to the urgency of what he was living through. This window between diagnosis and treatment planning was an excruciating time for our family, as it is for so many. Newly diagnosed patients and their loved ones must wait, ever at mercy to a scheduling system, wishing, hoping, and praying for an appointment to open sooner.

Just two years later, my husband Mike received the call: there was a mass in his pancreas. He went in for a biopsy, and shortly thereafter it was confirmed he had cancer. I came into that experience with something most caregivers don’t have: enough industry knowledge to understand when something had gone wrong in the system rather than accepting it as the patient’s burden to bear. I used it constantly. Together, we started the journey and the fight for his life.

After six rounds of chemotherapy, his nausea was unmanageable. His doctor had already tried two different medications without relief. She decided to try a third, but when we arrived for this seventh treatment, we were told the new medication was denied. I requested the denial code, but was told there wasn’t one — just a handwritten note.

I could read between the lines enough to know what that meant: without a denial code in the order, it had likely never been formally submitted. I called the billing department to inquire, and was told it was too expensive, and it was decided we should try the other medication again. Unfortunately, this wasn’t an option for us; I saw what my husband went through, and what clearly wasn’t working.

I remember stating simply: this is a decision between the provider and the patient alone — not one the center should be making on his behalf. In the end, the medication was eventually covered, and it finally brought my husband some relief. But no one should have to fight that fight, least of all in the middle of treatment.

Then a new calendar year arrived, and his deductible reset. After a full year of treatment, coverage that had been in place simply stopped. My husband was told he had to pay the cost for the full treatment while they navigate obtaining a new prior authorization for the new year. It wasn’t malicious — it was a system that didn’t have intelligence in place to trigger reminders. I felt lucky I knew enough to advocate. I never stopped thinking about the people who didn’t.

The view from both sides

What Alyssa witnessed from behind a front desk and what I lived as a caregiver are two sides of the same problem. When the administrative infrastructure surrounding oncology care fails — when the process is too manual, too fragmented, too slow to surface what matters — the cost can land on everyone in that building. On the staff who can’t afford to look up from the screen. On the patient who sits untracked in a waiting room. On the caregiver who spends hours fighting a denial that could have been prevented.

Oncology providers are among the most specialized clinicians in medicine. They have trained for years to understand treatments of extraordinary complexity, to make decisions that are genuinely life and death, to guide patients and families through something most of us hope never to face. That expertise doesn’t disappear when the administrative burden is too heavy — but access to it becomes so much harder.

A delayed authorization is often a delayed treatment. An unresolved claim is a phone call a staff member is making, which may take time away from helping a patient. A coverage gap is a medication that may stop being refilled — or become an impossible choice between medicine and other expenses.

The administrative and the clinical are not separate tracks. In oncology, they run together. When one fails, the other feels the lapse.

We've both been there, in the room with oncologists and the patients they serve. That firsthand view of system and experience is the reason we work the way we do. Building technology like athenaIDX® for oncology organization means accepting that the margin for error is different here. The role of the technology supporting that work is to keep pace — not just to automate, but to anticipate, to catch what might otherwise fall through, to give the people on the front lines the clarity and capacity to do what they came to do. And the patients the peace of mind that comes from having to worry less about how to pay for the care.

The numbers make that obligation concrete. This year, roughly 2.1 million people¹ will be diagnosed with cancer in the United States. Nearly 70%² of them will likely encounter prior authorization delays in their care. One in three faces the possibility of waiting a month or more. The average oncology practice currently spends 13 hours per week per physician on prior authorization requests alone — hours that belong somewhere else entirely.

We know what it costs when those hours are consumed by process, on top of direct patient care.  That's not incidental to what we build with athenaIDX. It's the whole reason.