2026年10月2日 / 美国东部时间凌晨5:00 / KFF健康新闻
得克萨斯州凯尔市——肯尼·布卢伊特十多年前被诊断出患有肺病，但今年首次出现急性发作，让他感觉自己无法呼吸。
布卢伊特的妻子辛迪表示，丈夫将这种急性发作描述为“世界上最可怕的事情”，并补充说，虽然每次发作通常持续不超过几分钟，但频率越来越高。
除此之外，倒垃圾这类简单的家务活都会让布卢伊特喘不过气。他很少出门，最近还瘦了45磅。“那听起来像是癌症，”辛迪回忆起丈夫的一位医生说过的话。她说，很明显，丈夫因数十年吸烟导致的健康状况正在恶化。
正因如此，6月2日，布卢伊特的肺科医生为他开了一种新药，用于缓解慢性阻塞性肺疾病（简称COPD）引发的严重呼吸问题。但处方并未立即配药。就诊两天后，布卢伊特收到沃尔格林药店的邮件，称“由于我们正在解决的保险问题”，用药被延误。
“他原本很期待这种药能起作用，”丈夫去世两个月后，辛迪说道，“我真希望我们当时有机会试试看。”
保险延误和拒付已成为美国医疗体系中臭名昭著的问题，今年1月KFF健康追踪民调显示，近70%的成年人认为这是“一个重大问题”。
2025年6月，联合健康集团首席执行官在纽约遇枪击事件六个月后，特朗普政府公开宣布了一项行业承诺，数十家大型健康保险公司签署了该承诺，旨在消除部分阻碍或延误患者获取医生推荐治疗的壁垒。但这项承诺是自愿的，企业不遵守也不会受到处罚。事实上，KFF健康新闻7月发布的一份报告发现，部分签署承诺的保险公司并未按最初设想落实所有承诺的举措。
近年来，在联邦层面未能出台实质性改革的情况下，包括得克萨斯州在内的大多数州的议员都试图通过监管保险业来解决延误和拒付问题。但大多数健康保险计划，包括传统医保政策和雇主赞助的保险计划——这两类计划覆盖了超过一半的美国人——通常不受州司法管辖。
即便一些医疗办公室职员和药房员工也对州和联邦交织的保险规则和条例感到困惑，而随着人工智能在索赔审批和处理中发挥更大作用，这一问题预计将变得更加复杂。
“这已经完全失控了，”Archō患者维权咨询公司首席执行官马特·托雷斯科说道。他认为，患者在面对保险障碍时需要更多帮助。
布卢伊特夫妇的故事表明，应对这些复杂流程对患者及其护理人员来说仍是一项艰巨的任务。
辛迪已向医保机构、肯尼的私人D部分药品计划、肺科医生诊所和沃尔格林药店寻求答案。她仍然不清楚谁该为用药延误负责，以及如何避免这次耽搁。
她不禁想问，如果6月7日周日下午布卢伊特的COPD急性发作本可以避免，他当晚是否还会选择自杀。
“复杂又令人费解”
辛迪表示，6月的第一周，丈夫多次询问他的处方——一种需要通过肯尼家中的雾化器吸入的液态药物——是否可以从沃尔格林药店取药了。
辛迪说，起初她并未对延误感到意外或担忧。据私募股权利益相关者项目的数据，沃尔格林去年被私募股权公司收购后，已在全美裁员数千人。辛迪在8月份表示，他们位于凯尔市的沃尔格林药店几个月来似乎一直人手不足，处方配药速度也变慢了。
辛迪在肯尼就诊几天后致电药店询问保险延误的具体情况，她说，一名沃尔格林员工告知她，该处方需要事先审批。事先审批又称预批准或预认证，是健康保险公司广泛采用的做法，要求医疗服务提供者在患者获得承保治疗前获得许可。
但辛迪不知道是肯尼的哪家保险公司要求对这种药物进行事先审批。
多年来，她一直帮丈夫打理多份保险保单。肯尼参保了A部分和B部分联邦医保，这是为65岁以上老年人或残疾人提供的健康保险计划。但他还通过Wellcare Value Script参保了私人D部分药品计划，以覆盖药品费用，同时还通过得克萨斯州蓝十字蓝盾参保了医保补充计划——又称“Medigap”计划，用于支付其他自付费用。
起初，辛迪以为是肯尼的D部分药品计划对新药启动了事先审批程序。但由于这是一种通过雾化器吸入的液态药物，该药物属于医保B部分耐用医疗设备福利覆盖的少数药物之一，而非D部分。
辛迪说，医保机构在电话中告知她，联邦政府没有记录显示该处方曾以肯尼的B部分保单进行过结算。
Wellcare Value Script的母公司Centene的发言人莎拉·坦纳和米丽娅·阿马亚不愿为本篇报道置评。
肯尼去世后，辛迪前往沃尔格林药店寻求 clarification，她说店员“说法一直在变”。她回忆起店员解释称，处方已提交给医保B部分，但缺少医生本应提供的必要诊断代码。
沃尔格林的发言人卡门·洛佩斯在9月下旬告诉KFF健康新闻，公司“无法评论涉及特定个人的事宜”。
辛迪随后表示，沃尔格林的一名地区药房主管致电她，称药房于6月2日，也就是肺科医生就诊当天，尝试通过B部分处理该处方，但处方缺少医生提供的诊断代码。主管表示，沃尔格林当天晚些时候已向肺科医生诊所发送了索要该代码的请求，辛迪回忆道。
肯尼的肺科医生——LungDocs的拉杰什·谢蒂并未回复KFF健康新闻的电话和电子邮件。但辛迪表示，诊所的一名员工告诉她，他们没有收到沃尔格林发来的索要处方诊断代码的传真。
与此同时，这不可能是肯尼的Medigap计划出了问题，因为这类保单不需要事先审批。
“除非请律师介入，”辛迪说，“否则我不确定如何才能查明真相。”
未来更多繁文缛节
非营利组织COPD基金会患者外联与教育高级主任迈克·赫斯表示，混淆B部分和D部分的区别是很常见的情况。“医保这些年来变得如此复杂和令人费解，”他说，即便医疗办公室职员和药房员工也常常误解其中的细微差别。
医生们表示，随着人工智能引入预审批流程，医保受益人应对保险障碍的难度可能会进一步加大。
长期以来，传统医保与医保优势计划不同，很少使用事先审批。但今年1月，医保在亚利桑那州、新泽西州、俄亥俄州、俄克拉荷马州、得克萨斯州和华盛顿州六个州启动试点项目，测试使用人工智能预审批部分医疗服务。
医保及医疗补助服务中心主任穆罕默德·奥兹表示，该项目旨在“根除传统医保中的浪费”，但医生和患者表示，该项目给医保受益人带来了更多繁文缛节，并导致了不当拒付。目前该试点项目并未对COPD药物实施事先审批要求，但行业专家预计，该项目的范围将扩大到更多服务和州。
6月7日晚，就在丈夫最后一次COPD急性发作数小时后，辛迪·布卢伊特坐在自家后院门廊时，听到一声巨响。她以为是客厅墙上的画掉了下来。事实上，那是枪声。她在卧室发现了肯尼的尸体。
“我无法形容那有多可怕，”辛迪说。
她说，丈夫长期以来一直受心理健康问题困扰，多年前曾有过一次自杀未遂。健康状况恶化只会让情况更糟，她说。
肯尼在留下的便条中证实了这一点。他告诉辛迪，她是一位了不起的妻子、母亲和祖母，但他的健康状况太差，无法继续活下去。
辛迪说，第二种COPD药物是她丈夫的肺科医生在6月2日就诊期间直接从制药商处订购的，在肯尼自杀数周后才送达。
“或许，只是或许，”辛迪说，“如果他能及时拿到这两种药，他今天还会在我们身边，我们还能共度更多时光。”
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Patient dies by suicide after “insurance issue” delayed medicine for lung disease flare-ups
October 2, 2026 / 5:00 AM EDT / KFF Health News
Kyle, Texas — Kenney Blewett was diagnosed with lung disease more than a decade ago but started experiencing flare-ups this year that made him feel like he couldn’t breathe.
Blewett described those flare-ups as “the scariest thing in the world,” said his wife, Cindy, adding that while the episodes typically lasted no more than a few minutes, they had become more frequent.
On top of that, simple tasks, like taking out the trash, left Blewett winded. He rarely left the house and had recently lost 45 pounds. “That sounds like cancer,” Cindy remembered one of his doctors said. It was clear, she said, that her husband’s poor health, tied to decades of smoking, was getting worse.
That’s why, on June 2, Blewett’s pulmonologist wrote him a prescription for a new medication to improve the terrifying breathing issues caused by chronic obstructive pulmonary disease, or COPD. But the prescription wasn’t immediately filled. Two days after that doctor appointment, Blewett received an email from Walgreens explaining that, “due to an insurance issue that we’re working to resolve,” the medication was delayed.
“He was hopeful that it would work,” Cindy said of the drug, two months after her husband’s death. “I wish we had the chance to find out.”
A photo of Kenney Blewett on widow Cindy’s laptop. Kenney, who was diagnosed with lung disease more than a decade ago, died by suicide in June. Callie Richmond for KFF Health News
Insurance delays and denials have become an infamous feature of the American healthcare system, with nearly 7 in 10 adults calling them “a major problem,” in a January KFF Health Tracking Poll.
In June 2025, six months after UnitedHealthcare’s CEO was shot in New York, the Trump administration announced a highly publicized industry pledge, signed by dozens of major health insurers, to remove some of the barriers that block or delay patients from accessing doctor-recommended care. And yet that pledge was voluntary, and it carries no penalties if companies fail to comply. Indeed, a report published by KFF Health News in July found that some insurers that signed the pledge would not implement all the promised initiatives as originally outlined.
In recent years, lawmakers in most states, including Texas, have attempted to address delays and denials by regulating the insurance industry in the absence of substantial federal reform. But most health insurance plans, including traditional Medicare policies and employer-sponsored offerings, which together cover more than half of all Americans, typically aren’t under state jurisdiction.
Even some medical office staff and pharmacy employees find the patchwork of state and federal insurance rules and regulations confusing, a problem that is poised to become more complicated as artificial intelligence plays a larger role in approving and processing claims.
“It’s just gotten completely out of hand,” said Matt Toresco, CEO of Archō, a patient advocacy and consulting company. He argued that patients need more assistance facing insurance hurdles.
The Blewetts’ story illustrates how navigating these complexities remains a herculean task for patients and their caregivers.
Cindy has sought answers from Medicare, Kenney’s private Part D drug plan, his pulmonologist’s office, and Walgreens. She still has questions about who was responsible for the medication delay and how the holdup could have been prevented.
If the COPD flare-up Blewett experienced on the afternoon of Sunday, June 7, could have been avoided, she wondered, would he still have chosen to die by suicide that night?
“Complex and convoluted”
During that first week of June, Cindy said her husband repeatedly asked if his prescription — a liquid medication meant to be inhaled through the nebulizer machine Kenney owned — was ready to be picked up from Walgreens.
Cindy said she wasn’t initially surprised or worried by the delay. Since its acquisition by a private equity firm last year, Walgreens has cut thousands of jobs across the country, according to the Private Equity Stakeholder Project. Cindy said in August that their Walgreens pharmacy in Kyle seemed to her to have been understaffed for months, and that prescriptions were being filled more slowly.
When Cindy called the pharmacy a few days after Kenney’s appointment to find out more about the insurance delay, she said, a Walgreens employee told her the prescription required prior authorization. Also called preapproval or precertification, prior authorization is a practice widely used by health insurers that requires medical providers to seek permission before their patients may receive covered treatment.
But Cindy didn’t know which of Kenney’s insurers required prior authorization for this medication.
For years, she had helped manage multiple policies on behalf of her husband. Kenney was insured by Medicare Parts A and B, the federal health insurance program for people 65 and older or with disabilities. But he also had a private Part D plan to cover drug costs through Wellcare Value Script, as well as a Medicare supplement plan through Blue Cross and Blue Shield of Texas — also called a “Medigap” plan — that paid for other out-of-pocket costs.
Initially, Cindy assumed that Kenney’s Part D plan had invoked prior authorization for his new medication. But because it was a liquid that is inhaled through a nebulizer machine, this drug was one of relatively few covered by Medicare Part B’s durable medical equipment benefit, not Part D.
The federal government had no record showing that this prescription had been billed to Kenney’s Part B policy, the Medicare agency told Cindy over the phone, she said.
Sarah Tanner and Myriea Amaya, spokespeople for Centene, Wellcare Value Script’s parent company, would not answer questions for this article.
After Kenney’s death, when Blewett sought clarification at the Walgreens pharmacy, she said the employee “kept saying different things.” She recalled his explaining that the prescription was submitted to Medicare Part B but without a necessary diagnostic code that the doctor should have included.
Carmen Lopez, a spokesperson for Walgreens, told KFF Health News in late-September that the company “cannot comment on matters involving specific individuals.”
Subsequently, Cindy said, a district pharmacy supervisor for Walgreens reached out by phone, and told her the pharmacy tried to process the prescription through Part B on June 2, the same day as the pulmonologist appointment, but that the prescription was missing a diagnostic code from the physician. The supervisor said Walgreens sent a request for that code to the pulmonologist’s office later that day, Cindy recalled.
Kenney’s pulmonologist — Rajesh Shetty of LungDocs — did not respond to phone or email messages from KFF Health News. But Cindy said an employee at the practice told her they did not see a fax from Walgreens asking for a diagnostic code for the prescription.
Meanwhile, it couldn’t have been an issue with Kenney’s Medigap plan, since those policies don’t require prior authorization.
“Short of getting attorneys involved,” Cindy said, “I’m not sure how to find out what really happened.”
Cindy Blewett at home in Kyle, Texas. Since her husband Kenney’s suicide in early June, Cindy has tried to figure out how an insurance delay — which may have exacerbated her husband’s anxiety and depression — could have been avoided. Callie Richmond for KFF Health News
More red tape ahead
Confusion surrounding these Part B and Part D distinctions is common, said Mike Hess, senior director of patient outreach and education at the nonprofit COPD Foundation. “Medicare has gotten to be so complex and convoluted over the years,” he said, that even medical office staff and pharmacy employees often misunderstand the nuances.
And with the introduction of AI to the preapproval process, navigating insurance hurdles will likely get more complex for Medicare beneficiaries, doctors say.
Historically, traditional Medicare, unlike Medicare Advantage, used prior authorization sparingly. But in January, Medicare launched a pilot program in six states — Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington — testing the use of AI to preapprove some healthcare services.
It is intended to “root out waste in Original Medicare,” CMS Administrator Mehmet Oz has said, but physicians and patients say the program is creating more red tape for Medicare beneficiaries and leading to inappropriate denials. The pilot program does not currently impose prior authorization requirements on COPD medications, but industry experts expect the scope of the initiative will grow to include more services and states.
On the night of June 7, hours after her husband’s last COPD flare-up, Cindy Blewett was sitting on their back porch when she heard a loud noise. She assumed a picture had fallen off the wall in the living room. In fact, it was a gunshot. She discovered Kenney’s body in their bedroom.
“I can’t tell you how horrible it was,” Cindy said.
She said her husband had struggled with his mental health for a long time and had attempted suicide once before, years ago. His deteriorating health only made things worse, she said.
Kenney confirmed that much in a note he left. He told Cindy that she was a wonderful wife, mother, and grandmother but that his health was too poor to continue living.
A second COPD medication, which his pulmonologist ordered directly from the drug manufacturer during the June 2 appointment, arrived several weeks after Kenney’s suicide, she said.
“Perhaps, just perhaps,” Cindy said, “if he had received both medications in a timely manner, he would be here today, and we would have had many more years together.”
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