We want United Health Care Insurance to uphold their original authorization for bilateral hip replacements for Andy Frey having met all deductibles and copays.
This petition made change with 94 supporters!
May 29, 2014
This brief letter is an outline of dates which is presented to the Appeals Board for United Health Care to review. I am insured through my wife's policy through her employment. I am in need of two procedures that require a total hip replacement of my right and left hip due to genetic bone disease resulting in bone on bone performance of the hip joints.
Please sign my petition because if the insurance companies continue to authorize procedures and then find ways to cancel them they are essentially playing God and now determining who can and cannot have health care. We pay $800.00 a month for health care insurance with a $10,000 deductible before the insurance will even begin to pay so what good is paying all this money if you cannot get the care you are paying for??
We believe that United Health Care Insurance is now stalling waiting for the policy to renew in August 2014 so they can collect another $10,000 in deductibles before re-authorizing the surgery they already authorized for May 2014 and June 2014.
We received a notification letter dated May 12, 2014 and not post marked until May 20, 2014 and then not received until Friday,May 23, 2014 from United Health Care that the surgery scheduled for May 28, 2014 (not even five days away) was denied due to being a "medically unnecessary "procedure for "arthritis". The letter never mentioned the procedure was for replacement of the hip due to degenerative bone disease. I felt this was a clerical mistake made by the office of United Health Care. Being distressed with the information we just received via the USPS regular mail, not by overnight/required authorization meant it was 5:30 p.m. on the Friday before surgery and a holiday weekend. Therefore, leaving us with no time for any response which was totally unacceptable. Now we endured a weekend of un-easiness and what to do????? Wait is all we could do until any offices at the surgeon and/or United Health Care would be open on Tuesday, May 27, 2014 the day before the procedure was to be performed. First thing, Tuesday, May 27, 2014 Brittany at Dr. Heimbergers office called and explained that their office was in receipt of the copy of the letter we had gotten. At this time Brittany explained that their office would contact United Health Care and proceed with the follow up. She was in touch with me by phone thoroughout that day and finally called at about 5:15 p.m. to say the surgery was still scheduled for 7:30 a.m. but the choice for me was to proceed with the surgery with possibilty of insurance denial or continue to wait for futher discussion with United Health Care for any mistake/confusion that may need corrected. I opted to wait for futher explanation and the surgery was delayed until Monday, June 2, 2014 at 8 a.m. I received this letter of denial on May 23, 2014 for a scheduled surgery which was authorized to occur on May 28,2014 by United Health Care Insurance.
My surgeon, Dr. Heimberger of Mcloed/Seacoast Orthopedics has tried to work out these details with United Health Care over the last several days which has now been denied for a second scheduled surgery on June 2, 2014. The reason for these denials of service from United Health Care are vague and not understood by myself or the surgeons office. Dr. Heimberger had stated that he has never witnessed any insurance provider to disallow a procedure in which a degenerative bone disease requires a replacement of the hips as to bring back the full extent of a "quality of life" for a patient to be able to live with out the pain and discomfort of the disease.
On or about December 9, 2013 the surgeon diagnosed me with degenerative bone disease explaining that my hip joints are operating on bone on bone and that surgery will be required. Dr. Chambers was my next referral and I went to the scheduled appointment with him about December 29,2013. At this appointment, Dr Chambers also agreed with Dr. Jarret that surgery would be required on the hips due to degenerative bone disease of both hips.
Dr. Chambers explained to me that with my weight issue and body mass index that he would like to see me lose approximately fifty to sixty pounds and that he will set a referral to a specialist for gastric sleeve or lap band procedure. I never received this referral due to the fact that United Health Care under my policy does not cover this procedure. I could not afford the $17,000 procedure so I have dieted and tried to be more physical to allow me to lose weight which I have. Dr. Ferguson also set up some physical therapy through Clemson Rehabilitation Service and I proceeded to go to these treatments every other day for a five week process. This therapy taught me breathing and stretching exercises to help with the pain which I continue to do these exercises each day.
I called Dr. Heimberger's office to schedule the hip replacement surgery on or about May 8, 2014. I spoke with Dr. Heimberger's assistant and scheduled the surgery for May 28, 2014 pending authorization/approval of my insurance provider. Brittany, the assistant, phoned United Health Care for this authorization and got back to me on or about May 12, 2014 to let me know that the deductibles and out of pocket requirements for my policy have been met and with exception of the $500.00 medical/ surgery co-pay which was at this time given approval to proceed.
All being set for surgery I was scheduled for the pre-admision class set for May 20,2014 at 10 a.m. This pre-admission class was set at Mcleod/Seacoast hospital where the $500.00 medical/surgical deductible was paid and all testing would be preformed for the surgery and presented to the PCP for final release to have the needed surgery. At this time a blood work up, EKG, chest Xray, nose swab for staph infection, etc. were performed and the group was presented with the "what to expect" and follow up care for total joint replacement. The group of people having surgery for total joint replacement in the following two week period was very informative and a tour of the facilty was given to the patients and their coaches.
After the class I was scheduled for a follow up for surgical release with Dr. Ferguson, my PCP. I went to the scheduled appointment with Dr. Ferguson on May 21, 2014 and the results from all the pre-admission testing for the hip replacement came back "good to go". Dr. Ferguson then required a nuclear stress test before her final release. She referred me to Pee Dee Cardiology for the stress test the next day and I attended this appointment and an additional follow up with Dr. Ferguson was on May 23, 2014.This release for surgery was given to me for the surgery by Dr. Freguson.
The next two days, Brittany was in discussion and phone conversation every hour on the hour with United Health Care to find any response to this situation. Brittany filed for a review of the case at 10:00 a.m. Thursday, May 29, 2014 and was told she would hear back within a twenty four hour period. At 3:00 p.m, on Friday May 30, 2014 Brittany phoned me and was still waiting for the determination in regards to the claim. She then explained that she would be in touch as soon as she heard anything. I received a call from Brittany at 4:57 p.m. to hear that United Health Care still denied the claim for the hip replacement surgery. I asked why and was told that I would have to be in contact with United Health Care for any determination. I immediatlely had my wife, as the policy holder, call only to be told that they would only speak to the patient in this matter. I then phoned United Health Care and finally after a series of recordings and questions by an automated system got ahold of a blood pumping live human being. Dustin was speaking to me on the phone and listened to my concerns and stated that he would have to be in touch with claims as to any answers to my question for the denial. After holding for approximately 20 minutes and the possibility of my cell phone battery being used up, Dustin was back on the phone and could give me no answer to the question of denial but that I would have to file an appeal to the claim. All I wanted to be answered was why the denial and what needs to be done for the approval of this procedure and all I could be told was to file an appeal in regards to the claim. Therefore, I still have the question of WHY this claim is denied and WHAT I can do to rectify the situation. At this point, the degeneration in my right hip has gotten to the stage that I am not able to get in and out of a car or drive. I am in constant pain and not able to sleep in a bed or chair but am forced to sleep either on the floor with my legs propped up or kneeling in front of my chair with my head in the seat if the chair. I am not able to do the simple chore of putting on shoes and socks (my wife has to do this for me). I cannot continue with this pain and the impairment it has caused and have relied on my doctor's assertion that hip replacement is the only solution to relieve my pain and return to normal daily functions. Due to the loss of bone and cartilage in both hips, there is nothing to be prescribed that will relieve that pain. This is now being denied to me by the insurance company refusing to authorize the payment for my surgery.
Thank you for reading my story and please sign my petition to get United Health Care Insurance Company to reverse their decision considering they already authorized the two surgeries earlier in the month.
Andy and Robin
Today: Cheri is counting on you
Cheri Carlson needs your help with “United Healthcare Insurance: We want United Health Care Insurance to uphold their original authorization for bilateral hip replacements for Andy Frey having met all deductibles and copays.”. Join Cheri and 93 supporters today.