5 Days, 3 Insurance Plans, and 1 Missing Diagnosis Code

5 days.

That is how long Kenney Blewett waited on a nebulizer medication his pulmonologist prescribed on June 2. He had COPD. The flare-ups were coming more often, and he called them "the scariest thing in the world." 2 days after the appointment, Walgreens emailed: the prescription was delayed "due to an insurance issue that we're working to resolve." On June 7, after another flare-up, he died by suicide. Lauren Sausser told the story for KFF Health News last week.

Nobody can say the delay caused his death, and his wife, Cindy, doesn't claim it did. He had struggled with his mental health for a long time. What she wants is an answer to a simple question: what happened to the prescription? Months later, she still doesn't have one.

Look at what she was up against. Medicare Part A and B. A private Part D drug plan. A Medigap supplement. 3 sets of rules for 1 man. The pharmacy said prior authorization. But the drug was a nebulizer liquid, one of the few that bill to Part B as durable medical equipment, not Part D. Medicare said it had no record of a Part B claim. A pharmacy supervisor later said the prescription went in without a diagnostic code, and a request was faxed to the doctor's office that same day. The office said it never saw the fax. The drug plan's parent company would not answer questions.

One missing code. One fax nobody saw. 5 days.

I am not shocked, and that is the problem. Every doctor reading this has lived some version of it. The prescription is not a medicine anymore. It is a claim. And a claim has to travel through a pharmacy queue, a billing category, a code field, and a fax machine before anyone asks whether the patient can breathe tonight.

This is not about one bad pharmacist or one sloppy front desk. A COPD Foundation advocate told KFF that Medicare has become "so complex and convoluted" that even office staff and pharmacists misunderstand it. And Medicare is now piloting AI prior authorization in 6 states, Texas included. More gates are coming, not fewer.

Direct care cannot fix all of that. Medicare patients still need Medicare, and some drugs still have to go through insurance. But in a direct care practice, a stalled prescription is a text message, not a mystery. The patient has my number. The pharmacist can reach me the same day. Many common medicines we dispense at wholesale, in the office, before the patient walks out. When there is no claim in the middle, there is nobody to lose the fax.

In Texas, where the Blewetts live, even that last step is harder. Texas is one of the states that restricts direct primary care physicians from dispensing medicine to their own patients, and the DPC Coalition is pushing to change it.

I am not anti-insurance. Keep a policy for the wreck. But a sick man asking his wife every day whether his medicine is ready is not a paperwork problem. It is a question somebody should be able to answer in 5 minutes.

5 days is not an insurance issue. It is what happens when everyone touches the prescription and nobody owns the patient.

If you or someone you love is struggling, call or text 988, the Suicide & Crisis Lifeline.