Cigna Said No. His Doctors Said It Could Save His Life.

A rare cancer patient spent months fighting insurance denials for the treatment and transplant his physicians believed offered his best chance at survival.

Keaton Herzer’s year-and-a-half-long fight against a rare form of cancer could supply the plot for a TV drama series.

Along the way, Herzer, a 35-year-old Colorado software engineer and new dad, accumulated a lot of followers on social media sites like TikTok, with videos about his struggle – not just with the cholangiocarcinoma attacking his liver, but also with Cigna, the insurance giant managing his health plan.

Herzer had a dramatic breakthrough last summer – when he and his wife turned to artificial intelligence and a medical consultant to learn his cancer had an unusual genetic mutation that might respond to a new drug. But his hope nearly faded when Cigna initially refused to pay for it, saying the treatment was not yet approved for cholangiocarcinoma.

It took everything Herzer had – supportive top doctors, his large social-media following, and the patience to spend hours a day on the phone, often on hold — to convince Cigna to fund the medicine that worked wonders in shrinking his main tumor. Then he had to get them to approve a life-saving liver transplant that had been recommended by a team of renowned physicians.

When we connected with Herzer earlier this month, it had been nine weeks since a substantial portion of a cousin’s liver had been successfully transplanted in a Houston hospital. He looked fit and said he’d started going back to the gym. But even after a happy outcome that was featured in a People magazine story, Herzer resents the fight he had to wage against Big Insurance in the age of prior authorization.

“It’s a full time job, right?” Herzer says. It was already stressful figuring the best course of treatment and undergoing a battery of tests before the successful transplant. “And then on top of that I got to figure out, ‘Who do I call? How do I get this thing approved? Am I going to go broke trying to pay for this therapy?’”

He lamented: “We think this is the way that health care should be and it doesn’t need to be like that.”

And for every case in which a persistent patient overcomes the roadblocks thrown up by Big Insurance and becomes a feel-good narrative worthy of People magazine, there are many others we don’t hear about, because a claim denial is the end of the story.

Herzer is aware of data showing that as few as 1% of patients appeal insurers’ denials of potentially lifesaving treatments or medications. Cigna – which administered Herzer’s claims for the California-based insurer, HealthNet, used by the family construction business that he works for – and its contractor, EviCore, a Cigna subsidiary, insisted that both his game-changing medication and his transplant were either too experimental or not “medically necessary.” That was news to the doctors keeping him alive.

Herzer is young, college-educated, well-connected, internet savvy, and aware of the advantages he had to break down the obstacles put up by the health insurance giants who raked in $54 billion in profits during 2025.

“And the way that they do that,” he said of those profits, “is by creating a system that’s so bureaucratically convoluted and complex and designed to make the average person give up.”

Cigna was the subject of a scathing 2023 investigative article by ProPublica that looked at its high rate of claims denials – more than 300,000 in one year, according to its report – and found the company was using a program in which doctors were often issuing denials in a matter of seconds, without opening a case file.

Herzer knew little of this in the fall of 2024. He was a healthy 33-year-old consumed with the arrival of his son, who was a year old, when he started feeling unusual stomach pains on his right side below the ribs. He thought it might be a gallbladder infection and went to the emergency room, where he received an ultrasound he believed was just a precaution. Instead, the test revealed one 11-centimeter mass on his liver, and several smaller ones.

After more tests, Herzer learned, “this turned out to be a somewhat rare form, not your straight-up liver cancer.” Doctors told him he had Stage 4 cholangiocarcinoma, a rare form of bile duct cancer, which only afflicts 8,000 to 10,000 U.S. patients every year. His type was intrahepatic – on both sides of his liver – which is even rarer.

His oncologists put Herzer on a cocktail of cancer-fighting drugs that they believed he’d need for the rest of his life. That was discouraging news, he recalled, even before he learned after a few months of therapy that his tumors were growing, not shrinking.

“My wife and I kind of looked at each other and said, ‘We got to be way more aggressive with my treatment, we got to find something else, we got to think outside the box.’” That’s when they looked more closely at his genetic markers – running the information through an AI program and consulting an outside expert. His rare genetic mutation had a promising targeted therapy called Zenocutuzumab. The problem was that the U.S. Food and Drug Administration (FDA) had approved the medicine to treat pancreatic cancer and lung cancer but not yet cholangiocarcinoma, despite extensive trials. That triggered the first denial letter from Cigna.

“At that point we had two options: we could pay out of pocket for this therapy, or I could just wait and do nothing,” Herzer said. He was not the type to do nothing. He and his wife decided to drain their life’s savings and spend more than $77,000 for each of the two treatments.

During a fraught month, Herzer kept calling his insurance company and asked his doctors to write peer-to-peer appeals. The campaign for coverage finally convinced Cigna to reverse course.

The news got even better from there. After a few months of the novel therapy, his tumors shrank by as much as half. The world-class experts at Houston Methodist and MD Anderson Cancer Center now considered him a good candidate for a life-saving liver transplant.

Cigna did not agree – even after the insurer had paid for all the scans, biopsies and other tests needed to determine if the transplant could happen.

“Once I was able to be evaluated for transplant, once I was shown to be a good candidate for the only curative option on the table for me, they denied that, too,” Herzer said. “I was like, ‘I’m not messing around with this. It’s a full court press.’” He went through the same round of internal and external appeals but also reached out to leading health care advocates and engaged Claimable, the AI-powered platform that helps patients submit custom appeals. He also wrote letters to Cigna CEO David Cordani and other Cigna officials, always copying lawyers and even prosecutors.

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Herzer also started recording his calls to both HealthNet and Cigna – such as the ones where he was told to call a specific case manager, then told his policy didn’t have case management – and began posting them on social media.

At first, Cigna insisted that while Herzer met the other transplant requirements, they would only pay for the procedure if his largest tumor – now down to five centimeters – would shrink to three centimeters.

“They were going to let me die slowly of cancer over two centimeters,” he said.

Around the time he filed a last-ditch formal appeal, his videos started going viral, garnering millions of views and causing his new supporters to post angry comments on Cigna’s Instagram page. Two days after his videos blew up, Herzer’s nurse supervisor called. Payment for the transplant had been approved.

Herzer’s good fortune accelerated quickly after that. He found a willing and perfectly matched donor in his cousin Stephanie, who can expect the roughly 35% of her remaining liver to grow back to full size, as will the 65% that was donated to Herzer on March 30. More than two months later, Herzer said he feels healthy, with tests showing no signs of active cancer. He recovered one of his $77,000 payments from the insurer, and hopes to recoup the other.

Despite all the good news, Herzer regrets the stress of his ordeal, and the broader state of health care in the nation where he had to take to TikTok to plead for life-saving treatments. While he was fighting to survive his cancer he sometimes had to spend eight hours a day on the phone to see his insurer’s denial documents and learn who was making decisions for Cigna. In the first rejection for his therapy treatments, he discovered the physician who rejected his claim was an ob-gyn, and not an oncologist.

Given a second chance at a healthy life, Herzer’s wish is that no one else would have to go through what he just did.