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March 06, 2006
The United Saga Continues
The head of customer care at United called just as I was leaving the office on Friday. She says UnitedHealthcare will not cover Leo’s tissue expanders because the procedure code (11960) does not allow more than one expander.
I patiently explained to her that Leo would then need four separate surgeries to insert each expander, four separate hospitalizations ($15,000 each), as well as four separate rounds of anesthesia ($2500 each) for a total cost of $70,000, but she wouldn't budge. I also explained that United had no problem paying for the removal of the expanders ($39,000). When dealing with insurance problems, it is very important to keep track of the who, what and when, so I took copious notes. The United rep promised to call the woman who handles insurance at our doctor's office on Monday to see if it could be worked out.
I'm not giving up yet. My editors here at BusinessWeek want me to take this problem directly to Terry McGraw, and I plan to do just that.
Meanwhile, Leo had a second round of tissue expanders inserted in his lower back last Tuesday, and he is doing well, all things considered. His roommate in the hospital was a very sweet 10-month-old baby with cancer. The baby has been at NYU Hospital for six weeks getting chemo and other treatments. His mother has spent every one of those nights sleeping on a skinny pull-out chair. My heart goes out to her and her family.
I can't say that the last year has been easy, but we are blessed that Leo has a problem that can be fixed.
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Thanks for taking the initiative to do this, Lauren. Our daughter Megan was born almost 10 years ago with the same birthmark condition as your son Leo. We have had our ups and downs with several different insurance companies over the years. I can attest to the fact that tenacity pays off. Megan has had medical expenses which, although initially turned down, have been ultimately paid. One thing I would add to your checklist is to get your medical team together. In the case of our birthmark kids, there are some top-of-the-foodchain doctors who know much more than the "specialist" down the street. Most are quite approachable. Get them on your side, get them writing letters, and use their published articles from major medical journals to argue your points. This has always gotten our insurers' attention. Do your homework. THEN don't give up :)
Posted by: Mark Beckwith at March 6, 2006 04:16 PM