Wednesday, May 13, 2009

A day in the life, or, how United Health Care sucks

Natalie was scheduled to go in for a procedure tomorrow to implant a subdural device to diffuse hormones to arrest her early onset puberty (she'll be nine in June), which threatened in turn to stunt her growth and subject her to schoolyard taunting. The device is very expensive (ca $20k) and the procedure to implant it not cheap (ca $3k).

To get approval for the device, we had to actually speak to the manufacturer to confirm that we had coverage, and we did, with United Health Care, I thought, which one of my now former employer's partners had assured me was part of our "Cadillac benefits package" (how apt the GM analogy seems today). Turns out the device was covered by Medco, not UHC. Praise the Lord.

So this morning we get a call from William F. of United Health Care's Customer Care Denial team who tells us that the procedure is not covered. Quoth he: "...one of our doctors reviewed the claim and notice that the device (covered by Medco, already shipped by the manufacturer) is approved for use by symptomatic females up to age 8, while your daughter is 8 years and 11.25 months of age..." William F, it must be owned, was well suited for his role in the Customer Care Denial department, as he remained calm and unflapped as Mary and I berated him vigorously and I threatened to blog. Little did I know there was a whole blogosphere out there devoted to the theme "United Health Care Sucks".  So UHC, unlike other companies, doesn't really worry about bad blog press, as there's already so much out there.

So over the course of the day we've had conversations with:
  1. United
  2. Our pediatric endicrinologist
  3. Our pediatric surgeon
  4. The device manufacturer
  5. My Professional Employer's Organization and Cobra administrator (not to be confused with my former employer)
And, as you can imagine, nothing is resolved, though we've been told the device has been shipped and Medco has covered it, which is some comfort.

3 comments:

Anonymous said...

My understanding is that they are considered one of the worst health insurance companies, in terms of whether and how much they pay. When I go to a new doctor and tell them we have United Healthcare (which unfortunately we do), I always feel bad.

Anonymous said...

I hate them too, so I forgot my "blog party manners." I should have also said that I'm sorry all this happened. I imagine you guys and Natalie had all psyched yourselves up for surgery today, and now it won't happen yet and you will argue for a while and then presumably they'll cover it and you'll have to psyche yourselves up again. Bummer. I really am sorry.

Anonymous said...

One can only assume United wants you to take the old Soviet gymnast approach to precocious puberty, reduce the caloric intake below the amount necessary to produce the amount of fat needed to begin menstruation. United may not care about blogs but they are afraid of Congress and the newspapers, I'd suggest you contact the fourth estate.