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« United Healthcare Update | Main | 2008 JDRF Walk »

Arden Denied Healthcare

You may have read in an earlier post that Arden needs some dental work.  To briefly recap, because of her diabetes her dentist needs to do the work in a hospital.  Since the procedure requires Arden to be unconscious her blood glucose must be constantly monitored so that adjustments can be made intravenously.  She will also require post op care until we are certain that she is capable of keeping down food and liquids.  If we attempted to have the procedure in the dentist’s office it would be nearly impossible to regulate her blood glucose during and after the procedure.  This would put Arden in a very dangerous position that would almost certainly result in a seizure.  We did not want Arden to have to be put to sleep for this but there is no other option available. 

Rewind to one month ago...  I contacted our insurance company (United Health Care) immediately after Arden’s dental diagnosis to make sure they would cover the medical side of the procedure.  The representative I spoke with assured me that it would be covered.  That was four weeks ago.  I even called back a week later to double check and was again assured that there was no issue.

Fast forward to Monday November 3...  Now four days before Arden’s appointment and just one hour before we were to leave the house for a blood test that the anesthesiologist requires due to type I, we were informed by mail that the were rejecting our request for care.

I spent the next two hours on the phone fighting through a wall of CSRs and reasoning with supervisors.  I was finally able to get them to accept a verbal appeal.  The normal appeal process takes thirty days and we only have three.  Ironically, if Arden doesn’t have the procedure soon she’ll likely get an infection that the insurance company will have to cover and that will result in the exact same care that we are asking for today.

So right now, right this moment they are reviewing the letter Arden’s doctor sent that explains why the procedure must be performed in a hospital.  Make no mistake, they already know that they should be covering this.  We are being held at bay by contractual language that when interpreted with common sense removed allows them to denies Arden basic health care.  They are making a decision that lacks common decency and compassion to save them from paying a claim even though they know that not receiving this care potentially puts Arden’s life at risk and will almost certainly result in them paying a different claim in the near future.

I will be updating you all as soon as they call me with an answer.

UPDATE:  The appeal has been denied.  I’m researching options now.

The story continues here...

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