Dear United Healthcare
Dear United Healthcare,
Nearly one year ago (last April), my entire world was flipped upside down when I saw the “sad face” look on my primary care doctor when he came into my hospital room. I had been at Alvarado Hospital for almost two days, receiving IV steroids to treat optic neuritis and undergoing tests to ensure there was nothing more serious going on. My MRI results had come back, and there were abnormalities. The neurologist, Dr Ghausi, accompanying my doctor explained that damage to the nerves was found in my spine and my brain. He told me that they would of course do blood work to rule out anything that would mimic the damage done by Multiple Sclerosis, but they did not expect that to pan out. I had MS, whether I liked it or not.
In the beginning, my husband was a little more panicked than I was. I assured him things would be okay. I had health insurance, after all! We could get this treated. Sure, in the past they had denied nearly all of my claims, declaring nearly everything I was seen for by a doctor as a pre-existing condition, but they couldn’t do that here. I had never, ever been seen for MS, nor was I ever previously diagnosed with it. I followed up a week later as instructed with the neurologist. He requested that I set myself up for a second MRI. “Six months from now, so we can see how this is progressing, and then we can figure out what treatments to try. Before Oct. 1st.”
On August the 8th, my employer announced they would be transitioning all of us from UHC to Kaiser, effective Nov. 1, 2012. I discussed with my husband whether or not I should wait until we switched before having the second MRI. Nope, we decided. I had already established myself with Dr. Ghausi, I trusted him and I liked his staff. I needed to do as much as I could with him, so that I would be “armed” with more information when I was forced to see a Kaiser doctor. I scheduled and had my second MRI. On Oct. 3rd, I followed up. He explained that there had been “silent attacks” in the six months since my first. Copaxone was his recommendation. It would take a few days for the insurance authorization to go through, and once it did, I would be notified.
After a few days, I received the phone call from IV Solutions Pharmacy, United Healthcare had approved me for a three month supply of the medication, and a delivery driver would be by my home that very evening, and a nurse would be there afterward to show me how to administer the medication. I was relieved to finally be able to start treatment. That evening, after waiting two hours past the delivery driver’s promised time of 6pm, my meds were finally there. I questioned him about payment, he said there were no charges. My insurance had agreed to pay for everything. I even signed a receipt that said patient balance $0. “Usually I have to pay an $8 co-pay, but awesome!” I joked. I asked the nurse who came later that night, and he said the same.
I used Copaxone for about a week, and experienced some of the worst pain I had ever felt in my life. That entire week, I suffered. My husband had to administer a few of the injections, and after the very last one, he begged me to not make him do that again. Finally, after missing even more time from work, I called Dr. Ghausi. There was no way this was normal. He ignored my first call, so I called again, leaving an angry message with his MA. The MA called back very quickly. He told me that Dr. Ghausi advised that I stop taking the medicine. He began the process of getting me set up to qualify for the oral MS treatment, which would involve an EKG, blood work and urine tests, as well as a brief stay in the hospital to be sure my heart wouldn’t stop with the new meds, but I was running out of time. Nov. 1st was fast approaching and I knew there was no way I would be able to get all of that done by the time my employer switched us over to Kaiser.
Following the switch, I choose not to take any more time off. Missing work had become the norm for me, and I was running low on sick and vacation time. I needed to wait for more to build up before I made an appointment with a Kaiser doctor. I came down with the flu in Mid-December and caved. I made an appointment just so that I could bring a note into work letting them know I wasn’t faking being sick. I informed my new primary care about the recent MS diagnosis and my horrible experience with Copaxone. He assured me that Kaiser would take good care of me. He asked that I have my old records sent to him and get set up with a Kaiser neurologist.
Again, fear of missing even more time from work delayed me.
And then, toward the end of January, my husband got a phone call. IV Solutions wanted my insurance information. “That’s weird,” I responded when he told me. “I’m not using their medication anymore. Besides United already approved and paid for it. Kaiser definitely won’t let me use them for refills.” We shrugged it off. They were probably just trying for me to continue using them as my Copaxone supplier. Never going to happen.
Which brings us to yesterday (March 19th, 2013 at about 3:30PM). I was just finishing my last break for the day, when I was told I had a phone call. It was IV Solutions. They had called my coworker, and she was going to transfer it to my desk. The young woman, Roxanne, informed me that she needed my new insurance information. I asked her why they would need that if United Healthcare had already covered the medication I had received and I definitely was not planning to refill the RX. “United Healthcare denied the claim. There is a bill of $884,000 and we need to see if your new insurance will cover it.” My heart sank into my stomach. I told her I now had Kaiser, and asked why they would give me nearly a million dollars of worth of medication if my insurance hadn’t covered it. She blamed me for switching insurances. UHC had authorized the meds before the switch, but I had switched. I informed her that there was no choice in the matter. My employer forced us to switch, we are required to have health insurance per company policy. I asked why I was told I was covered when I clearly wasn’t. She told me I had been covered, but when the switch happened, UHC transferred responsibility of payment for the medication to me. “Shouldn’t I have been notified?” I demanded. “My insurance cannot approve you to give medicine that expensive and then require me to pay all of it! You told me I was covered. You told me it had been approved. I signed a receipt saying I owed nothing!” I began to break down. Roxanne changed her tune. She placed me on hold while she spoke with a supervisor. There apparently were some problems with the way UHC had handled their end of the deal. IV Solutions would work to appeal the denial. The authorization UHC sent them is good until October 2013, and IV Solutions was not notified by UHC that I was no longer covered until February of 2013. Roxanne assured me they would do everything they could to make UHC pay. If not, I would be responsible for nearly ONE MILLION dollars worth of useless medication that is currently taking up space in my refrigerator.
I guess what I am trying to say here, in this letter to you, United Healthcare, is that I am a 26 year old receptionist for a Church. A Nonprofit that helps the community. I make barely $11/hour after taxes, and I’m sure your CEO had a lovely Christmas bonus this past year. Even if I were to give 100% of my paychecks to pay for that medicine, it would take me 52 years. $884,000 may not be an enormous number to everyone, but for someone like me, that number means I will never be able to own a home in my lifetime. I am now worried that I may have to file for bankruptcy, which will ruin not only my credit but also that of my husband, unless of course we divorce before I file to protect him. The thought of that is emotionally crippling. I will fight you every day, for the rest of my life, until you make good on what you agreed to pay for. Something like this cannot be ignored, and I will do whatever I can to ensure you don’t do this to someone else.
Jessica M. Young