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Greetings, readers. While anecdotal evidence cannot replace statistics, it’s crucial to recognize the distressing trend within the U.S. insurance system. A recent case of an insurance-related suicide highlights the severe impacts of delays and denials, which can drastically affect lives. As insurance premiums rise at alarming rates, companies seem to be stalling more frequently on claims. For instance, after my own experience with Cigna, where they abruptly ceased processing my claims, it became clear that this issue transcends my personal frustration. Tragic scenarios, such as elderly couples forced to choose which medications to prioritize, exemplify the grim choices many face. Medicare, intended as a safety net, is not the solution it once promised to be, as many experienced physicians in New York City refuse to accept it, further limiting access to necessary care.
From a reader last month:
Could someone please investigate how Medicare is deteriorating from within?
Discrepancies in fees for Fee-for-Service versus Value-Based care.
Potential reductions of up to 23% for lab services.
Doctors receive 2.2% versus 2.7% based on their chosen approach.
Proposed changes might only allow 100% payment for the first service, dropping to 50% for any additional services during the same visit.
Additionally, the evolving regulations around AI in Medicare could complicate the process further, with delays and denials likely becoming more common—a troubling hallmark of the system.
By Lauren Sausser. Originally published at KFF Health News
Kenney Blewett had been living with lung disease for over a decade, but this year brought a series of severe flare-ups, making breathing feel nearly impossible.
Describing these episodes as “the scariest thing in the world,” Kenney’s wife, Cindy, noted that they were not only frightening but also increasingly frequent, lasting only a few minutes each time. Simple chores left Kenney out of breath, leading to a dramatic loss of weight—45 pounds. One doctor had even suggested a cancer diagnosis, hinting at the serious deterioration linked to years of smoking.
Consequently, on June 2, Kenney’s pulmonologist prescribed a new medication aimed at alleviating his debilitating COPD symptoms. However, the prescription encounter didn’t conclude smoothly. Just two days later, an email from Walgreens informed Kenney of an “insurance issue” that was delaying his medication.
“He had hope that it would work,” Cindy said, reflecting on her husband’s untimely death two months later. “I wish we could have discovered its efficacy.”
Delays and denials from insurance companies have become a well-known problem in U.S. healthcare, with nearly 70% of adults in a January KFF Health Tracking Poll identifying them as a major concern.
In June 2025, six months after an unsettling event involving the CEO of UnitedHealthcare, the Trump administration unveiled a high-profile pledge by various health insurers aimed at reducing obstacles preventing patients from obtaining recommended care. Unfortunately, this undertaking was entirely voluntary, lacking any penalties for noncompliance, and subsequent reports found that many participating insurers would not adhere to the promised initiatives.
Amid growing concerns, legislators in most states—including Texas—have tried to tackle delays through state-level regulations. However, most health insurance plans, including traditional Medicare and employer-sponsored options, do not fall under state oversight, which limits these efforts’ effectiveness.
Even healthcare professionals express confusion over the intricate web of insurance regulations that many find bewildering, a situation likely to worsen with the increasing role of artificial intelligence in claims approval.
“Things have spiraled out of control,” said Matt Toresco, CEO of Archō, a consulting firm advocating for patients. He emphasized the need for enhanced support to help patients navigate insurance barriers.
The situation surrounding Kenney Blewett exemplifies the extreme complexities patients and caregivers must navigate in the U.S. healthcare system.
Cindy explored multiple avenues for answers regarding the medication delay, reaching out to Medicare, Kenney’s private drug plan, his pulmonologist’s office, and Walgreens. Unresolved questions lingered about who was accountable for the halt in medications and what could have been done to prevent it.
Could Kenney’s COPD flare-up on the evening of June 7 have been averted, she pondered, thus impacting his tragic choice to end his life that night?
‘Complicated and Confusing’
Throughout that week, Cindy recounted how Kenney had consistently inquired about the readiness of his prescription—a liquid medication designed to be inhaled via a nebulizer. While she initially didn’t find the delay surprising, having noticed Walgreens having staffing issues since they were bought by a private equity firm, she later discovered that the prescription required prior authorization—a common hurdle where medical providers must secure permission before patients receive covered treatment.
Unfortunately, Cindy didn’t know which of Kenney’s multiple insurance plans required prior authorization for the medication.
She had been managing various insurances for her husband. Kenney held Medicare Parts A and B, a private Part D plan from Wellcare Value Script for drug expenses, and a Medigap plan from Blue Cross and Blue Shield of Texas to cover additional costs. Initially, Cindy suspected that the Part D plan was responsible for the authorization delay. However, because this specific medication was classified under Medicare Part B—a designation that typically lands under durable medical equipment—she learned that it had not been billed to Kenney’s Part B plan.
After Kenney’s passing, Cindy received inconsistent responses when she attempted to gather clarity on the matter from Walgreens. An employee informed her that the prescription had been submitted to Medicare but lacked a necessary diagnostic code from the doctor.
Walgreens spokesperson Carmen Lopez declined to provide specific details on individual cases.
Later, a Walgreens pharmacy supervisor reached out, explaining that the prescription had originally been processed under Part B but was missing a diagnostic code. They relayed that a request for this code had been sent to Kenney’s pulmonologist on the same day as his appointment.
Cindy was told by an employee at the pulmonologist’s office that they didn’t receive the requested fax from Walgreens.
In this scenario, the Medigap plan posed no issues, as such policies do not require prior authorization.
“Short of involving lawyers, I’m at a loss for uncovering what truly transpired,” Cindy lamented.
Increased Challenges Ahead
Given the complexity surrounding distinctions between Parts B and D, confusion is commonplace, noted Mike Hess, senior director of advocacy and regulatory affairs at the nonprofit COPD Foundation. “Medicare has become so intricate and convoluted over time,” he commented, leading to misunderstandings even among medical and pharmacy staff.
With AI’s introduction into the prior authorization process, navigating insurance challenges is likely to become even more daunting for Medicare patients, according to healthcare professionals.
Traditionally, Medicare employed prior authorization sparingly, unlike Medicare Advantage. However, in January, Medicare commenced a pilot program across six states—Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington—implementing AI for some healthcare service preapprovals.
The initiative aims to “eliminate waste in Original Medicare,” said CMS Administrator Mehmet Oz, but both physicians and patients report that it has created additional bureaucracy and led to unwarranted denials. Although COPD medications currently are not subjected to prior authorization under the pilot program, it is expected that this approach will expand to cover more services and states.
On the night of June 7, after Kenney’s last COPD flare-up, Cindy was sitting outside when she heard a loud noise, initially assuming it was a picture falling. The grim reality revealed itself to be a gunshot; she found Kenney’s body in their bedroom.
“Words cannot describe how horrific that was,” Cindy recounted.
Having struggled with mental health challenges for years, Kenney had attempted suicide before, and his declining health exacerbated his hardships.
In a note he left behind, he reassured Cindy of her wonderful qualities but expressed that his health had deteriorated to a point where he could no longer endure life.
Following Kenney’s suicide, a second COPD medication—originally ordered directly from the drug manufacturer during Kenney’s June 2 appointment—arrived several weeks late.
“Perhaps, just perhaps,” Cindy reflected, “if he had received both medications promptly, he might still be here today, and we could have enjoyed many more years together.”
