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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsOutrageous reason UnitedHealthcare halted critical surgery... and LAUGHED while mocking suicidal patient
Outrageous reason UnitedHealthcare halted critical surgery… and LAUGHED while mocking suicidal patient
Deborah Copaken anxiously felt the prick of the needle in her arm under the stark lights of the hospital room as she prepared to be sedated.
The Brooklyn-based mother-of-three was about to undergo a vital operation to help her hear again after the sudden onset of deafness from a COVID infection in the summer of 2022.
Her doctor, Dr. Babak Sadoughi, was already scrubbed and ready for surgery.
But then, just seconds before she was set to be wheeled into the operating room, her insurance company - UnitedHealthcare - contacted the doctor's office.
Approval for the procedure had been denied as it was 'not medically necessary'.
-snip-
https://www.dailymail.co.uk/news/article-14187439/united-healthcare-rejected-insurance-claim.html
More cases in the article.
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Silent Type
(7,343 posts)done in a physician’s office and relatively inexpensive.
MrsCoffee
(5,824 posts)It was so painful they had to abandon the procedure in her doctor’s office and planned to do it under general. United blew off her doctor’s office that called daily. She got new insurance the next year and finally had her surgery without any denials from the new company.
Silent Type
(7,343 posts)Heck, give her nitrous oxide. They pull teeth, do root canals, etc. under this stuff.
This is another reason we will never have MFA. Because patients want Cadillac treatment, and don’t give a damn about the cost.
Heck, it’s highly likely it won’t work. The dang doc wouldn’t even try to get it approved, telling the woman to call.
JMCKUSICK
(611 posts)I live in pain every hour of every day and I can't begin to imagine her suffering.
It's really really hard not to get pissed off at the basic insensitivity and ignorance to excruciating pain that you so ably betray.
There are millions of you too, the ones that don't believe us, the ones who encourage us to get over it, buck up, stop being lazy, and so on and so on.
What I pray you can do is to take some responsibility for the information I'm about to give you thereby ensuring no further ignorance on yet another matter.
You hurt people when you say or act towards us like this.
I love you man and for as many awakenings that I've experienced in this last week, I hope you get to experience that same blessing.
moniss
(6,151 posts)has been filled with joint pain. Except for a single time of cartilage tear removal my family never took me to a doctor. Any time I did certain things the pain would follow within hours and the next days would be debilitating. I was constantly chastised by my parents and siblings as being "lazy" and "no good". The joint pain now that I'm old is just brushed off by doctors as "arthritis". So I've never been away from chronic pain for the most part or forgotten a life with parents who would constantly rip and ridicule their own child.
JMCKUSICK
(611 posts)that affects addicts and people with invisible to the naked eye medical issues that exposes a sorry lack of empathy and compassion that has only gotten worse as we've increasingly isolated and limited our exposure to others to social media.
That what you experienced wasn't and isn't seen as criminal neglect is revolting.
I'm sorry.
moniss
(6,151 posts)how they could be different as night and day when visitors would stop by. I remember thinking in my head how bad I wanted to leave with them or to tell them or anybody. But I knew what would happen. They would turn the "good face" to anybody questioning anything and then when that front door closed I knew what would happen to me.
Arazi
(7,078 posts)You must be one of those who believe women shouldn’t have pain relief in childbirth. Or refuse to pay the anesthesiologist for the “full surgery”. Or circumcise babies without meds.
Ffs, you have no idea what another person’s pain levels are.
Please delete 🤬
Silent Type
(7,343 posts)always allow them.
There is much more to the story than pain. A few Xanax, nitrous, or something else if contraindicated. There is no way to get universal healthcare like MFA if we pay whatever providers charge and prescribe when they make money off it. They tried that at inception of Medicare and it failed.
But, I’d like to see what her doctor sent to insurance showing guidelines that even our government programs require.
Arazi
(7,078 posts)Nor are you a pain management specialist.
Nor can you authoritatively predict what “usual” meds may or may not work for one person via another. Nitrous absolutely does NOT work for some people. Anxiety can override Xanax or other tranquilizers.
Silent Type
(7,343 posts)the same thing.
Medicare would have questioned a claim like that after an earlier one and the need for general anesthesia. Although under Medicare might have been denied after the fact, leaving the lady to pay.
Admittedly I don’t know, but you are speculating too- My guess is doc didn’t fight for it because he wasn’t really sure it was necessary, but he had an open slot. Again, I don’t know that for sure, but I’d want whatever company I’m paying my premiums to look at medical records to see if doc followed Medicare/Medicaid Guidelines before just writing a big check.
Arazi
(7,078 posts)They had tried other methods but because of her anatomy, it wasn’t feasible.
Did you read the story?! She switched to another insurance company (presumably during open enrollment) and they approved the surgery without question.
I can’t believe I’m actually arguing this.
choie
(4,705 posts)Silent Type
(7,343 posts)were met, looking at cheaper options, etc., is not unsympathetic, it’s prudent and any universal healthcare system Congress finally enacts will include such audits, whether before service or after.
Keepthesoulalive
(811 posts)Or medical decisions. No one is reigning in all the blood sucking monsters in our health care system.
There are so many unnecessary hands in the pot making money at every opportunity , you can’t fault the patient, fault a bought and paid for congress who refuses to pass any laws that will stop the wealth extraction that is “healthcare “.
paleotn
(19,532 posts)and not someone on the internet with limited facts. No offense.
Silent Type
(7,343 posts)paleotn
(19,532 posts)So we throw the baby out with the bath water to ensure that someone, somewhere, somehow isn't getting something YOU, all knowing, all seeing YOU think isn't the most cost effective treatment. And in the aftermath, some people die unnecessarily. But hey! We derailed the schemes of all those pesky, crooked docs. Sorry but I'll stick with the opinions of the experts. I'm funny that way. It's generally a safer position to take when it comes to ...you know...fucking dying! 
Incidentally, I asked a few days ago, are you somehow connected to the parasitic health insurance industry? I'm getting that vibe. Just curious. Haven't gotten that vibe from anyone here since the ACA was being debated.
Silent Type
(7,343 posts)at least half of them are Republicans.
paleotn
(19,532 posts)Silent Type
(7,343 posts)and hospitals killed people.
Most of the anecdotal denials I’ve seen would have been denied by Medicare, Medicaid, and many countries with universal healthcare.
paleotn
(19,532 posts)Death and unnecessary suffering cause by an industry you, for some unknown reason, have chosen to champion. But, hey! You be you. Here's the tip of the iceberg.
https://www.buzzfeed.com/morgansloss1/18-stories-health-insurance-claims-being-denied
https://www.yahoo.com/news/medical-professionals-sharing-infuriating-stories-173217042.html
https://www.thedailybeast.com/my-insurance-company-killed-me-despite-obamacare/
Unqualified medical practice? Now that could end badly, wouldn't you say?
https://pmc.ncbi.nlm.nih.gov/articles/PMC10391242/
Silent Type
(7,343 posts)all anecdotal (but I'm sure some are real as further discussed), no real details, and many of them would not have been paid or approved by our model government programs or many plans in European countries.
One was a clinical trial that might not have met government program requirements for reimbursement such as under Medicare.
One was having trouble with insulin cost. I would too, but that's big pharma charging $800 and incurring shortages. And, Congress got off its rear and corrected that.
Another was a mother -- rather than a doctor -- trying to get her daughter into an inpatient facility for drug addiction rehab. Well, government programs have requirements too-- patient has to be capable and desirable of participating in treatment; cannot engage meaningfully; and even after entering rehab, patients must meet Medicare's ongoing benchmarks to maintain their stay. Some even require outpatient treatment.
I stopped at that point.
Some of the examples are true and regrettable (those are a prime target for lawsuits) and many would happen under government programs here and in other countries; but I know for a fact the other components of our so-called system are just a guilty, maybe more so.
If Congress would act, we either wouldn't have health insurers, or they would would be highly regulated -- including denials and reports to consumers -- and audited for compliance.
Instead, Congress is probably laughing its rears off while we point fingers at private insurance and praise Luigi. No, reason for them taking action. Heck, I think one reason Congress does nothing is that they don't want the heat of complaints that are inevitable.
What would really be convincing is if you found legal cases where patients, their family, estate, etc., sues an insurance company for death because of a denial. I would find that quite convincing.
One can sue if the company acts negligently, wrongfully denies a claim, or drags out the process. You can also sue if the insurance company misrepresents the terms or benefits of your policy, or engages in fraudulent activities.
paleotn
(19,532 posts)This vast raging sea of seething wrath and anger is just a whole lot of to do about nothing. it's all a few anecdotal tales. Insurance companies = good after all. Take it from you. THE EX{PERT on all things of this nature. 
My 30+ year, health care professional wife, looking over my shoulder at your posts, said something about you not knowing your rear end from a hole in the ground. Not sure what she means by that, but I do get the distinct impression she doesn't like you very much. Oh! She also thinks you're full of shit. Hey, her words, not mine. 
Celerity
(46,866 posts)You face up in this thread as being almost desperate to defend it and to mitigate or discount major criticisms of it, including your use of classic sealioning techniques.
Not only do you clearly have a bug up your butt against doctors, but you are almost irrational when you talk about anything related to this topic.
Horse with no Name
(34,076 posts)And we don’t cheat. You should be calling your hospital compliance hotline otherwise you are as guilty as they are.
Response to paleotn (Reply #9)
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choie
(4,705 posts)The vitriol oozes out in every post.
Ms. Toad
(35,623 posts)Unless, of course, you have a Medicare (dis)Advantage plan.
There are only a handful of procedures that even require pre-authorization (generally those which can be either cosmetic or medically necessary - depending on the reason). Otherwise, if the doctor believes it is medically necessary it is approved.
Silent Type
(7,343 posts)Based on estimates from surveys administered between 2001-2012 (Oehlandt, 2022; Shan, 2019), ETD affects 4-5% of adults. Medical management is frequently used for treatment of associated conditions, but success rates are limited. Established surgical approaches include myringotomy (creating a hole in the eardrum) and tympanostomy (small tubes implanted through a hole in the ear drum). (Tucci, 2019).
In 2019, the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) published a set of consensus statements regarding the use of BDET (Tucci, 2019). The published consensus statements were reached using the Delphi method. This involved the iterative consideration of statements by a panel representing a variety of medical specialty societies until consensus was reached. The target population for the statements was adults 18 years of age or older who had symptoms for 3 months or longer that significantly affected their quality of life or functional health status. The panel reached consensus on the following 18 statements regarding selection of candidates for BDET:
A comprehensive history and physical exam, including otoscopy, are essential parts of the diagnostic evaluation of a candidate for BDET.
Nasal endoscopy is an essential part of the diagnostic evaluation prior to BDET.
BDET is contraindicated for patients diagnosed as having a patulous ETD.
Nasal endoscopy in patients who are candidates for BDET is necessary for assessing the ET lumen and assessing the feasibility of transnasal access to the nasopharynx. A diagnosis of patulous ETD is suggested by symptoms of autophony of voice, audible respirations, pulsatile tinnitus, and/or aural fullness.
The benefit of repeat BDET after a prior ineffective BDET has not been determined.
Symptoms of obstructive ETD can include aural fullness, aural pressure, hearing loss, and otalgia.
Tympanometry is an essential part of the diagnostic evaluation prior to BDET. 8.50 0
Establishing a diagnosis of obstructive ETD requires ruling out other causes of aural fullness such as patulous ETD, temporomandibular joint disorders, extrinsic obstruction of the ET, superior semicircular canal dehiscence, and endolymphatic hydrops.
Patient-reported symptom scores alone are insufficient to establish a diagnosis of obstructive ETD.
Nasal endoscopy is necessary to rule out extrinsic causes of ETD.
Comprehensive audiometry is an essential part of the diagnostic evaluation prior to BDET.
BDET is appropriate in patients with obstructive ETD who have failed medical therapy for identified treatable causes.
Common causes of obstructive ETD that benefit from identification and management are allergic rhinitis, rhinosinusitis, and laryngopharyngeal reflux.
Medical management of known pathology that could affect nasal or ET function is appropriate to perform prior to BDET.
Patients with a history of recurrent baro-challenge, defined as uncomfortable pressure in the ear upon exposure to ambient pressure
changes that cannot be easily relieved, may improve following BDET.
There is no scientifically proven or standard medical therapy for ETD.
Pneumatic otoscopy can identify negative pressure in the middle ear space and can differentiate between adhesive and non-adhesive retractions of the tympanic membrane. . . . . . .
https://www.anthem.com/dam/medpolicies/abcbs/active/guidelines/gl_pw_e002209.html
Arazi
(7,078 posts)Did you not read her story? Any of it? Your entire post doesn’t address her case. At all.
You persist in somehow trying to exonerate UHC. It’s unbelievable that you still, somehow, believe you know better than this woman’s doctor. Did you not read that she switched companies and THEY APPROVED THE SURGERY IMMEDIATELY unlike UHC.
‘I went deaf from the inflammation that shut down my Eustachian tubes and essentially glued them shut with scar tissue. In the wake of that, I did everything by the book,’ she told DailyMail.com.
‘This was a clear-cut case of medical need. From one day to the next, in the summer of 2022, I went deaf from Covid.’
Steroids didn’t work and Dr Sadoughi tried a balloon Eustachian tube dilation surgery under local anesthesia.
‘It was so excruciatingly painful, because I have a deviated septum, that I screamed throughout the entire procedure, and we had to abandon it,’
Ms. Toad
(35,623 posts)who has a specific patient in front of them, with a specific history, with which the doctor is familiar. That doctor made the assessment that she needed this surgery. My daughter has been taking medications for years against the consensus guidelines for treatment for a rare liver condition. Over that period, the guidelines have changed twice. Her medications have always been covered by insurance (at least 4 different plans).
Which brings me to the second point: The guidelines you quoted from were written in 2019, before COVID. Little is known about how COVID-related deafness is similar to (or different from) other deafness. Guidelines are not fixed in stone - they change as new information is available - and COVID is a whole lot of new information.
Finally, you linked to an anthem reference. Anthem has nothing to do with how traditional Medicare works. With few exceptions, Medicare follows the doctor's assessment of medical need.
Passages
(1,430 posts)UnitedHealthcare Tried to Deny Coverage to a Chronically Ill Patient. He Fought Back, Exposing the Insurer’s Inner Workings.
by David Armstrong, ProPublica; Patrick Rucker, The Capitol Forum; and Maya Miller, ProPublica
Feb. 2, 2023, 5 a.m. EST
https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis
vanessa_ca
(70 posts)This part really warmed my heart:
I hope his first targets are the Healthcare-sharing ministries that were exempted from regulation in the Affordable Health Care Act thanks to the work of a lobbyist for the industry. This case was just as disgusting:
Despite a history of fraud, one family has thrived in the regulatory no man’s land of health care sharing ministries, where insurance commissioners can’t investigate, federal agencies turn a blind eye and prosecutors reach paltry settlements.
-snip-
Luckily, or so Martin thought, she had placed her trust — and her money — in Liberty HealthShare. Liberty is what’s known as a health care sharing ministry, a nonprofit alternative to medical insurance rooted in Christian principles. Hundreds of thousands of people rely on such organizations for basic health coverage. They promise no red tape, lower costs and compassion for the sick. Although Martin wasn’t religious, she found comfort in Liberty’s pledge to “carry one another’s burdens.”
-snip-
For generations, members of the Beers family of Canton, Ohio, have used Christian faith to sell health coverage to more than a hundred thousand people like Martin. Instead they delivered pain, debt and financial ruin, according to an investigation by ProPublica based on leaked internal documents, land records, court files and interviews. They have done this not once but twice and have faced few consequences.
-snip-
Four years after its launch in 2014, the ministry enrolled members in almost every state and collected $300 million in annual revenue. Liberty used the money to pay at least $140 million to businesses owned and operated by Beers family members and friends over a seven-year period, the investigation found. The family then funneled the money through a network of shell companies to buy a private airline in Ohio, more than $20 million in real estate holdings and scores of other businesses, including a winery in Oregon that they turned into a marijuana farm. The family calls this collection of enterprises “the conglomerate.”
-snip-
Despite abundant evidence of fraud, much of it detailed in court records and law enforcement files obtained by ProPublica, members of the Beers family have flourished in the health care industry and have never been prevented from running a nonprofit. Instead, the family’s long and lucrative history illustrates how health care sharing ministries thrive in a regulatory no man’s land where state insurance commissioners are barred from investigating, federal agencies turn a blind eye and law enforcement settles for paltry civil settlements.
-snip-
Passages
(1,430 posts)vanessa_ca
(70 posts)JMCKUSICK
(611 posts)There are literally millions of these stories and yet nothing more than talk in congress.
Big Oil gets Billions in subsidies
The MII gets over 800 Billion dollars a year, every year
Big Business gets outrageous tax breaks and perpetual settlements with DOJ for fines for their crimes.
The wealthy get to buy a literal seat at the table so they help write the deal.
What do they all have in common?
LOBBYISTS.
This is THE one issue where R's and Dems can all speak the same language.
We need a million medical victim march on Washington and to spend every free moment being our own lobbyists in that we can ring their phones off the hook.
Litmus test for any future candidate MUST be at minimum full on for Insurance reform and full investigation into RICO statute violations.
Georgia would be a gr5eat place to start with their more liberal (pun intended) RICO statutes.
This is a perfect example of talking about healthcare vs fighting for healthcare.
paleotn
(19,532 posts)Silent Type
(7,343 posts)than Republicans according to Opensecrets. Guess they were paying not to stir the pot, and we didn’t.
JMCKUSICK
(611 posts)Too big to fail has yet another big business friend.
One more question, the people that are supposed to help folks navigate the ACA sites and options, are they allowed to say UHC has double the denial rate of any other Co?
Guessing not.
Silent Type
(7,343 posts)JMCKUSICK
(611 posts)it turns out. I know that sounds harsh, but sadly it's true.
Silent Type
(7,343 posts)vanessa_ca
(70 posts)I love it! Though I'd probably change that to "a million victim medical march" to get more doctors and healthcare workers on board, but that's silly quibbling.
Seriously, I love that!
I was speaking with my sister last night, who's a highly rated radiologist, and she's been so spitting angry about this issue for years that she, a diehard Dem, wants to drop the Dem party altogether and get other people on board to start a new independent party that committed to medical and financial justice. I think that's a fantasy, but a non-partisan march is a great doable idea and it would pull in people from all parties, all walks of life (other than the insurance industry and its praetorian guard lackeys).
I will be watching very closely to see which political representatives act on this scandal and will not not support any who don't.
lame54
(37,209 posts)Going into a tunnel
Meowmee
(6,127 posts)It’s criminal that they get away with this type of thing.
Skittles
(160,331 posts)without showing that psycho coward shooting someone in the back
sheshe2
(88,155 posts)Do you have a better source for these stories? They are a RW tadloid.
Daily Mail is a news media source with an AllSides Media Bias Rating™ of Right.
What a "Right" Rating Means
Sources with an AllSides Media Bias Rating of Right display media bias in ways that strongly align with conservative, traditional, or right-wing thought and/or policy agendas. A Right bias is the most conservative rating on the political spectrum.
Daily Mail Rated Right in Aug. 2022 Blind Bias Survey
The Daily Mail was rated Right by people across the political spectrum in the Aug. 2022 Blind Bias Survey.
On average, respondents who self-identified as being on the Right rated the Daily Mail as Lean Right. Respondents in all other bias categories – Left, Lean Left, Center, and Lean Right – rated it as Right.
Democrats and Independents rated the Daily Mail as Right, on average, and Republicans rated the Daily Mail as Lean Right.
A total of 771 people from across the political spectrum rated the bias of the Daily Mail. The weighted average was 3.73, which is in the Right category. The middle 50% of responses lied between 1.88 (Lean Right) and 5.42 (Right) – an interquartile range of 3.54.
https://www.allsides.com/news-source/daily-mail
vanessa_ca
(70 posts)this one was accurate and convenient and saved me from having to make 3 different OPs that would get lost in the shuffle. I stand by my OP regardless of the messenger.
sheshe2
(88,155 posts)You can post them all on this thread. The Daily Mail is a far right source and not reliable.
How can you say that a RW source is accurate? I don't get it. That is like saying FOX is accurate.
vanessa_ca
(70 posts)Sorry if that wasn't clear to you.
ColinC
(10,956 posts)
Autumn
(46,668 posts)Ask a chronic pain sufferer why they can't get pain meds. One fucking reason. Politicians.
Nittersing
(6,921 posts)He recently posted this rant:
So gd tired of prior auths. No more Dr. Nice Guy. Yesterday a gay male patient’s refill for generic Truvada for PrEP was denied. Here’s my response to their PA request. It’s the only way I can keep my sanity and avoid burnout.
Vinca
(51,241 posts)I also read that insurance companies are using AI to determine whether something is medically necessary and it's wrong about 90% of the time.