Experience. Results.

One man’s lawsuit exposed UnitedHealthcare’s shameful tactics

On Behalf of | Feb 24, 2023 | Long-Term Care

What started as Christopher McNaughton’s long journey to find an effective treatment for his debilitating ulcerative colitis led to a cluster bomb of evidence composed of incriminating emails and recorded phone calls from UnitedHealthcare. This peek behind the curtain revealed the long-perceived but rarely displayed insincere dealings of healthcare insurance providers working to dictate treatments based on cost, not patient welfare.

The story could comfortably fill an entire season of a soap opera, but here are the highlights:

After years of trial and error in treating his ulcerative colitis, McNaughton was referred to a gastroenterologist at the Mayo Clinic, who eventually zeroed in on a successful treatment regimen. The catch was that the treatment was wildly expensive, causing United to flag his account as “high dollar amount.” Unsurprisingly, this led to a theatrical series of events that ended with McNaughton losing coverage for his treatments and a bill for more than $800,000.

After failed appeals, McNaughton filed a lawsuit. Most patients give up hope at this stage rather than go to court, which is why United was eventually coerced into releasing its damning internal communications regarding McNaughton’s case. Though United repeatedly said the denials weren’t about the cost, the case, and its expenses, are said to have been monitored at the highest levels in the company.

Representatives from United lied to both McNaughton and his Mayo doctor – later characterized as a procedural misunderstanding – and buried information that conflicted with cost savings, including a dire warning from McNaughton’s Mayo doctor about the extreme risk of reducing or stopping his treatments. While attempting to shave a decimal place off McNaughton’s medical costs, a doctor from the Medical Review Institute of America warned United that they were setting the stage for far more expensive hospitalizations and surgeries should they refuse the already costly treatments. United ignored this warning.

United’s shocking lack of empathy and immoral attempts to play doctor for an individual they had never examined or even spoken to did not play well in court. The most telling moments, apart from all the lies, were when one of United’s staff doctors, with no gastroenterology background, dutifully agreed to the unsafe treatment reduction based on a report written by a United nurse that had never seen McNaughton.

While all this was happening, United posted a profit of $20.1 billion in 2021 while giving its departing chief executive some $140 million in compensation.

United is still paying for McNaughton’s treatments – for now. The legal and PR backlash from the lawsuit has quieted their efforts to sabotage his coverage, though McNaughton fears he’ll have to go through this stressful ordeal every year for the rest of his life. In the meantime, he has returned to college to study healthcare law, so he can help others going through similar insurance nightmares.