Margaret sent a message to Stephen Hemsley – Chief Executive Officer of UnitedHealth Group Inc. email address that said:
Dear Mr. Hemsley,
I need your help, please! I have been a UHC Member for several years and have always been satisfied with my experience. I am hoping that you will truly look into my current situation and help me.
After being rear ended at full speed by a driver that was on PCP in May of 1992, I had to undergo three spine surgeries to save my broken spine and relieve severe pain in my back and neck. I was left with excruciating pain from instrumentation and other damage caused by the surgeons within UHC. It was determined that I was a failed fusion patient. It took me several years to go back to a doctor to get the care I needed because I had lost my trust. I have been a patient of Dr. Brian Subach since early 2009, when my neurosurgeon from Washington Brain and Spine declared that my case was too complicated for them to handle. They knew Dr. Subach would be able to give me the best result. After four surgeries (2 in 2009 and two in 2011) I was finally able to sit and stand without the pain I had been experiencing for several years. Dr. Subach truly saved my life. Now I am in dire need of cervical surgery and am being denied coverage. Yes, Dr. Subach is out of network, but my secondary coverage (Medicare) covers his costs. From what I understand, Reston Hospital Center is not allowing us to move forward with my surgery because UHC is denying coverage, even though they are an IN NETWORK FACILITY. I have appealed this decision and have been denied again. The letter states that since the Doctor is out of network, the facility is automatically not covered. UHC is preventing me from getting the care I need at Reston Hospital Center, even though they are in network.
The letter also stated that they did NOT look at my medical records when making this decision. They would have seen that I have had 4 spine surgeries already with the exact coverage. Bottom line, I have spent countless hours on the phone trying to understand the policy, the appeal process and more. Frustrating hours spent with member advocates that all have different information or no answers.
I need this surgery with Dr. Subach at Reston Hospital Center as soon as possible. I was scheduled on June 1 and then June 22nd, 2016, but was denied authorization. PLEASE HELP ME! Please, I am begging you to reverse this decision, so I can please get the care I need. It has been a long and difficult road and I want and deserve the best care available. . Much Thanks, Margaret
