A shocking case has emerged involving United Healthcare, one of the biggest health insurers in the US, after it denied a claim for a patient who hemorrhaged in the brain and was put into a medically induced coma. The insurer’s reasoning? The hospital care provided was “not medically necessary.”
The patient, a 45-year-old woman, was brought to the emergency room after collapsing at home. She was quickly diagnosed with a severe brain hemorrhage by the doctors—one that was life-threatening and required immediate surgery and intensive care. She was placed in a medically induced coma to manage swelling in her brain and give her body the best chance of recovery.
Thank you for reading this post, don't forget to subscribe!UnitedHealthcare later denied the family’s claim for coverage, even though the situation was obviously urgent and critical. In a letter to the family, the insurer said it had determined the hospital stay and subsequent care “did not meet the criteria for medical necessity.”
Her family is appalled and bewildered by the verdict. “It’s unthinkable,” said her husband. “How could they tell us this was not needed? She would have died without such treatment.”
Tens of thousands of dollars’ worth of medical costs have been piled up on their head, and the family now also plans to pursue a court battle against the verdict of the insurance company.
Healthcare advocates and doctors have commented on the scandal, labeling the decision as “deeply troubling.” Dr. Sarah Edwards, a neurologist, said, “Brain hemorrhages are among the most severe medical emergencies. To suggest that hospitalization and intensive care are not necessary in such cases is both absurd and dangerous.”
Experts on the legal and insurance fronts cite the recent increasing pattern in the denial of critical care claims due to so-called cost-cutting. “This is not a first incident,” according to health policy analyst Ellen Hartman. “We see it increasingly often now that essential, sometimes even lifesaving treatment, is denied and leaves families with emotional and financial devastation.”
The incident has created renewed calls for health care reform as patient advocates insist their lawmakers take action regarding the denial of claims for necessary medical care. According to Karen Walsh, director of a nonprofit healthcare advocacy group, “No one should have to fight their insurance company in the middle of a medical crisis.” She said, “This is a systemic problem that needs immediate attention.”
The family is currently focusing on the recovery of the patient, while at the same time appealing the denial. According to legal experts, the chances of them overturning the decision are very good, since the care needed is very medically necessary.
UnitedHealthcare’s Statement
UnitedHealthcare had a brief response to media inquiries: “Our decisions are based on medical evidence and established guidelines to ensure appropriate care for our members. We are reviewing the details of this case to ensure our policies were applied correctly.”