Nurse Tiffany Auvil on Caregiving, Denials, and a Misdiagnosis

Tiffany Auvil spent more than twenty years inside the U.S. healthcare system, starting as a volunteer firefighter and eventually serving as System Director of Outpatient Clinics for a three-hospital health system. She is a functional medicine health coach, she is completing a Doctorate of Science in Integrative Healthcare, and she is the author of "The No BS Guide for Caregivers: How to Survive the Healthcare Maze," available now. Episode page with links and more  Her favorite mistake was trusting the system she had worked inside for two decades. Her husband Dave was treated for renal cell carcinoma in 2016 and was cancer-free within three months. Seven years later it returned in his pancreas and liver. The night before Dave's first immunotherapy infusion, the oncology nurse called to say insurance had denied it. Tiffany had done prior authorizations for years and knew the denial did not add up, so she called the insurer, who had no denial on file at all. The failure was upstream: the hospital's prior authorization specialist had entered a diagnosis code in the field meant for the procedure code, and the portal rejected it as invalid. When they arrived for treatment the next morning, the oncologist was relieved someone had finally figured it out, because she had been watching authorizations get denied without ever learning why. That was not the only failure. A Gamma Knife authorization later sat unsubmitted because nobody attached the clinical notes or pressed the button. And the cancer in Dave's brain turned out to be central nervous system lymphoma, an entirely separate primary cancer that Tiffany believes had been in his eye all along. Mark and Tiffany talk about diagnostic error and the cognitive bias that makes a second primary cancer nearly invisible, about Code Help and the escalation paths families are rarely told about, about what it costs to be the employee who questions things and tries to connect silos, and about why "good catch" recognition is where organizational learning usually stops instead of starts. Dave died at home in April 2025. He used to ask Tiffany what people do who do not have a Tiffy. The book is her answer: scripts for talking with physicians, how to read a bill, how to appeal a denial and how to tell whether a denial is even real, and a closing section on end of life that most caregiving books avoid. What You'll Learn Why insider knowledge is not the same as protection How a single field on a single screen became a denial that nearly delayed cancer treatment Why Tiffany filed a grievance after the problem was already fixed How cognitive bias makes a second primary cancer nearly invisible, even to excellent physicians What Code Help is, and why most families never hear about it What it costs to be the employee who tries to close loops between silos Why "good catch" is where learning usually stops instead of starts How to make a fifteen-minute physician visit actually work Why starting hospice earlier is a practical decision, not a surrender