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.