Help! I'm suing United Health Care-Denying medical needs

[Guest guest]

Hi Judy and everyone else,

Thanks Judy for responding and I apologize for taking so long to

reply back. Several things have happend on my end and I feel

devastated and heartsick.

I was tickled pink the last couple of weeks because I was finally

going to be able to go get myself " fixed " and hopefully get my life

back, and on March 3rd would be flying in to Boston to speak with a

surgeon, a Dr. Micheal Millis, who specializes in pelvic osteotomies,

a surgery which my OS says that I need pronto.

I have now found out that my insurance company, United Health Care,

has DENIED the referral request MY ORTHOPEDIC SURGEON gave to my

insurance company requesting that I be able to see Dr. Millis.

United Health Care took nearly 2 months to give me an answer about

whether or not they would allow me to travel to Boston for an

evaluation with Dr. Millis for a PAO. These decisions are only

supposed to take 10 to 15 business days; mine took nearly two

months. I finally began calling them every day, mostly being

told " your case is still under review. " To make a long story short,

one day when I called, I talked to three United Health Care

representatives that affirmed my case had been approved to see Dr.

Millis in Massachusetts, and yes they had the letter my orthopedic

surgeon had written them on my behalf requesting an approval to see

Dr. Millis because NO doctors here in Kentucky performed pelvic

osteotomies. After two months of headaches and spending my days on

the telephone, United Health Care finally told me I had been approved

to go to Boston for my evaluation with Dr. Millis.

Then, two days ago, my hips woke me up again and the pain was so

intense I tried to get up and barely made it. I could not put any

weight on my right leg, not even to steady myself. I thought I was

going to have to go to the hospital. I took two Vicodin back to

back, and waited to see what was going to happen. The pain stopped

in about an hour and a half. Having already been in the hurting

mode, I then decided to send a message to Dr. Millis's secretary that

morning about some MRI films, and lo and behold, only to find she had

emailed me earlier that morning and said that they had received a

letter dated Feb. 19 from my insurance company denying my approval to

see Dr. Millis. Now, what do you suppose happend? I understand

simple English. I have never, not to this day, gotten a letter of

denial from my insurance company. After I composed myself and quit

crying, I called UHC and they confirmed I was NOT approved. I then

asked them why three representatives lied to me over the phone and

said I was approved for the evaluation visit, and how come I hadn't

received a letter about the denial?

I had already taken my credit card and paid for two plane tickets and

lodging in Boston to see Dr. Millis, because, again, three reps at

United Health Care said I had the approval to go.

After I called them and they told me I had been denied, I also asked

them if they thought my Orthopedic Surgeon was lying about my need to

have to see another surgeon that does periacetabular osteotomies,

since none in Kentucky do this procedure? They also gave me names of

other surgeons in my area. I repeatedly told them those surgeons did

NOT perform PAO's and that one of them on the list was already one of

my doctors and I assured them none of them on the list could do the

surgery my OS says that I need.

As we all know, displasia is very painful and crippling. I don't

know what else to do except to sue my own insurance company. But I

will do it. Not only might it help me, but it may help someone else

down the road in need of the same thing. I know my insurance company

thinks I will just dry up and go away. But I won't!!!!

I am wondering, would it be easier to see Dr. Smet (I've seen him

listed on this site, and also a Dr. Mont) for hip resurfacing, and

how did others gain insurance approval to see them?

I have already been told by a nurse here in Kentucky that I should go

ahead and sue United Health Care for denying medical care to me. (At

this point, I agree.)

I need some pointers from others, has any of this happend to you?

I'm already out nearly $1,000 for round trip plane tickets to go to

Boston which included lodging; and of which is of no use now. Has

anyone else ever had to sue their own insurance company to get the

medical care they needed?

I told United Health Care I was going to sue them if they did not

grant me the approval to see a surgeon that could help me. I gave

them till the 29th to respond to the faxes I sent to their legal

department and to the appeals board.

I need help on this issue and pointers from anyone.

Thanks,

Terrie

> >

> > > My questions are: Successful Doctors in the US> (West

> Coast preferably)

> > Dr. Boyd in Salem OR did both of my hips when I was 40. I was

> severely bilaterally dysplastic. Nearly three years later, and I

am

> thrilled with my hips. I was at a rehearsal today, and needed to

> make a quick bathroom run. It is a piece that I don't play much,

so

> I ran for the bathroom, thinking if I hurried, I could get back to

my

> spot before I had to play. I ran back to applause, as most of

these

> people had never seen me run before! I've known most of them for

> over ten years!! One even said if she hadn't known me before my

> surgeries, she never would have guessed that I'd had bad hips. We

> had a rehearsal from 9-3 today, and other than lunch, I was on my

> feet for most of that time-no pain! In fact, I'm going to be

doing

> an aerobics step tape later tonight. Another first for me!

> > > What determines when> enough is enough - I know> that

is

> individual but I am struggling with saying> OK it's time.

> > What determined it for me was the increasingly negative impact

my

> hips were having on my life. I could have lived with the pain,

> although it was definitely bad. But, I couldn't live with the

> increasing disability. I had trained my German Shepherd puppy as

a

> service dog, just because he was so easy to train, and he loved

it.

> Thankfully, because I got to the point where life alone would have

> been very difficult without him. I finally decided to have

something

> done now while I was still young. If I had to be disabled, I

> rathered it would be when I was older and didn't have so much

energy

> instead of now, which are the best years of my life so far.

> >

> > Since my hips were done, I've hugely increased my range of

motion,

> done a lot more traveling (went hiking in Puerto Rico and

snorkeling

> in the Caribbean while still on crutches), started dating again,

and

> have a list of things I either have never done, or haven't been

able

> to do in a long time. On the list are things like learning to

dance,

> roller skating, scuba diving... Sadly my German Shepherd passed

away

> suddenly about a year and a half ago. Thankfully I didn't need

him

> as a service dog anymore, as the one I have now has no aptitude

for

> it. In fact, she would probably be the first one to knock me over!

> >

> > Cindy

> > C+ 5/25/01 and 6/28/01

> >

> > _______________________________________________

> >

> >

> >

> >