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KARE 11 Investigates: Lies, rigged system alleged in insurance denial

A lawsuit provides a rare look at the behind-the-scenes effort to avoid paying for care – and the roadblocks patients face in insurance appeals.

Lauren Leamanczyk, Brandon Stahl (KARE11), Steve Eckert

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Published: 4:28 PM CDT May 23, 2023
Updated: 9:08 PM CDT May 23, 2023

A college basketball player, Chris McNaughton was the picture of health until his junior year when he was diagnosed with ulcerative colitis at age 22.

His life changed. The painful disease inflames the digestive tract and causes ulcers. McNaughton lost 50 pounds, was repeatedly hospitalized, and became suicidal.

There is no known cure.

“I basically spent all day in the bathroom. I had bloody diarrhea 20 times a day. And then I would have stomach pains so bad that I would just sort of lay on the couch in the fetal position,” he said in an interview with the non-profit news organization ProPublica.

ProPublica shared its story – and the raw interview it did with McNaughton – with KARE 11.

Credit: Courtesy of Chris McNaughton

McNaughton went through failed treatments until he traveled from his home in Pennsylvania to Minnesota’s Mayo Clinic in May 2015.

There, Dr. Edward Loftus, a nationally renowned gastroenterologist, prescribed an infusion of a high-dose, high-cost combination of two drugs.

The treatment worked. The ulcerative colitis went into remission.

“To finally have something and be able to resume a normal life, it meant everything to me,” McNaughton said.

Credit: Courtesy of ProPublica
Chris McNaughton

Eager to get his life back on track, McNaughton enrolled at Penn State University and purchased the school’s student insurance plan, which was administered by Minnetonka-based United Healthcare.

United, one of the largest insurers in the country, covered McNaughton’s meds at first.

Then in October 2020, United temporarily “without notice, stopped paying for the infusions” while the company reviewed whether the drugs were medically necessary, according to a federal lawsuit he filed.

Credit: KARE 11
McNaughton filed a lawsuit against United Healthcare, accusing the insurer of wrongfully denying coverage for his ulcerative colitis.

The fear of having to go back to a life of agonizing pain put McNaughton back into a severe depression.

“I just remember being completely devastated,” he said.

What happened next provides an extremely rare look inside the insurance denial system and a behind-the-scenes effort to avoid paying for expensive medicine.

McNaughton’s lawsuit uncovered the myriad hoops he needed to jump through to get care.

“You sort of always, maybe imagine the worst. But this was beyond anything I could have imagined,” McNaughton said.

United Healthcare did not answer KARE 11 Investigates’ specific questions about the McNaughton case.

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