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Me vs. United: Round 11960


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February 24, 2006

Me vs. United: Round 11960

Lauren Young

On Wednesday, I took my son Leo to see his plastic surgeon at NYU. Good news. His back is all healed, and we are ready for his next surgery to remove the giant mole on his back. The surgeon has an opening next Tuesday, so Leo will be his first patient.

When I got into the office yesterday, I got a call from Tina Hager, the sweet nurse managing the McGraw-Hill account at United. She was simply checking in—she had no idea the next surgery was already scheduled. I’m sure that paperwork will cross her desk today. After I hung up with Tina, I was feeling pretty good, especially because I’d managed to get my act together to take a 7:30 a.m. yoga class. While Leo’s next surgery is happening very fast, we just want to get this chapter of our lives behind us.

That good karma didn’t last for very long, though. I got a not-so-lovely letter from United when I got home last night saying they rejected our appeal for Leo’s first round of tissue expanders. The crux of the problem is 11960. That’s the claim code for the surgery he had on Sept. 15 when he was 10 months old. According to the “carbon copy” of the letter I received from United, 11960 “is not eligible for benefits" under my insurance plan.

Since Leo is having the same surgery again next week, I’m freaking out a bit. Is this going to be another $18,000 procedure that is not covered by insurance? If so, I’m not sure if I have room on my credit card—I’m a personal finance writer so I only believe in having one credit card—to cover the balance this time around.

I vented with my co-workers this morning, sharing this tale with everyone and anyone I could talk to. When I griped about United to the editor who heads up our team of investigative reporters, he just scowled and said something to the effect of: “They are the worst. The bureaucracy is unbelievable.”

This has been dragging on for months now, and I’ll admit I’ve been a bit paralyzed by the whole experience. After all, this is my baby we are taking about. Thankfully, none of my friends who are parents can say they have been in the operating room watching their child be put under anesthesia four times in a 12-month period. I’ll try not to cry on Tuesday as I put Leo down on that table again. He’ll be holding his favorite toy, a soft one we named after Lucy the Elephant in Margate, N.J.

But time is short—I don’t have time to be sappy. I only have 60 days to appeal this appeal of an appeal. Thus, I left a desperate phone call for Tina, United’s patron saint, when I got back to my desk. I also sent her an SOS in an email. She called back within 20 minutes.

And, instead of writing a timely currency story and conducting the interview I had scheduled on some new retirement developments, I blew off my work this morning. Instead, I spent more than an hour on a conference call with Tina to try and sort this out. First we talked with John in United’s Rapid Response Department and later we spoke with Mark in the National Claims Center. The basic problem, as I understand it, is that United's coding system doesn't provide coverage for more than one tissue expander (at $4500 a pop) per day. Leo had four expanders inserted last Sept. 15, which means $13,500 in coverage is still outstanding.

Our appeal has now been sent to a supervisor. It's on the fast-track, which means it should be reviewed within the next 72 hours. In addition, I’ve been furiously emailing the human resources people here (ironically, a whole team of them are visiting United’s offices in Tampa today) with hopes that they can do something.

This is still a work in progress, but the one thing I've learned from all of this is that email is a beautiful thing. If you cc the right people, the whip starts cracking.

Since we are a self-insured company, I’m almost tempted to call up our CEO and ask him to instruct United to override the claim for these surgeries. Wouldn't that be nice?

04:35 PM

Health

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