NEW YORK, Dec 09 (Reuters): Jen Watson, a 41-year-old mother in Federal Way, Washington, has worked for years with her doctor to find the right medications to deal with her multiple chronic illnesses, which include epilepsy and fibromyalgia.
Her doctor had found some medications that could reduce Watson's nerve pain, but Watson says her UnitedHealthcare Medicaid plan refused to cover the drugs. And because of her pain, it has been hard for Watson to find work.
"I've been struggling to find work in part because I can't stand for more than 15 minutes and end up in serious pain very quickly because my symptoms aren't well managed," Watson told Reuters.
The killing last week of a powerful health insurance executive has ignited an outpouring of anger from Americans struggling to receive and pay for medical care. Police are still hunting for the man suspected of killing Brian Thompson, chief executive of UnitedHealthcare, and have not determined a motive. But the attack called fresh attention to deepening frustrations over health coverage.
Recent data show that patients are now even more likely to have their claims denied, pay more for premiums and medical visits, and face unexpected costs for care they thought was covered by their health plan. Rising costs are attributed in part to consolidation of doctors' practices, hospitals and insurers. UnitedHealthcare, part of UnitedHealth Group, is the largest manager of health benefits, followed by Cigna and CVS Health.
"It's a very shocking event. But it's also an opportunity for people to vent about issues that have been of great concern to many people," said Tahneer Oksman, a professor at Marymount Manhattan College's communications department in New York.
Americans pay more for health care than any other country and over the past five years, spending on insurance premiums, out-of-pocket co-payments, pharmaceuticals and hospital services has increased, government data shows.
Shares of UnitedHealth have nearly doubled over the last five years. During the week of the shooting, UnitedHealth shares fell by more than 10 per cent through Friday.
UnitedHealth, CVS and Cigna did not provide a comment for this story.
Insurance industry trade group AHIP said in an emailed statement that health plans, providers and drugmakers share responsibility to make care as affordable as possible and easier to navigate.
"Health plans are working to protect patients from the full impact of rising costs while connecting them to care that is safe, evidence-based and coordinated," the group said.
Insurers who manage health benefits and drug benefits say that they negotiate down prices of doctor visits, hospital stays and costly medications. Most plans are sponsored by employer or government clients who foot part of the bill and have a say in what gets covered.
Kevin Gade, COO at investment firm Bahl & Gaynor, which owns about 2.6 per cent of UnitedHealth shares, said companies like UnitedHealth play an important role in providing critical and needed care for all patients within an inefficient US healthcare system that needs to evolve. "Unfortunately, when you're dealing with people's lives, there is a reality that there will be hiccups along the way," he said.
Justine, 51, a UnitedHealthcare customer who works at a nonprofit in New York City, was diagnosed with breast cancer in 2017 and underwent a double mastectomy in 2018. She asked that her last name be withheld for privacy reasons.
