So it looks like the healthcare insurance company is not wanting to pay for the very expensive procedure that my son just had. Wow, how convenient is that?
Just FYI, they're United Healthcare. And they suck.
So, he's been in pain for like 18 months. They found a large bone cyst and no one would touch it except for a pediatric orthopedic oncologist, literally the regular orthopedic physicians would not see him, said he had to go to the super double specialist.
Total claim for everything including surgery and hospital stay was just a hair under $50k.
Now, United Healthcare is saying that the procedure was not medically necessary.
Really? Treating a bone cyst with a material that's been in use for 50 years is not medically necessary? Just crazy. Making me very upset at them.
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United Healthcare Services letter to us.
The introduction starts off .... "Based on the information submitted, we have determined that the requested service(s) is/are not medically necessary."
Then I guess they have an MD review all of this. This guy is (I guess) Alexander Y. Garibashvily, MD, Medical Director, Board Certified in Family Medicine. However, if they didn't make this so difficult for us, it would be comical because he's clearly using some type of voice transcription device that can't hide his broken English.
I'm imagining a thick Russian accent.
"Your doctor plans a special procedure for your son. This is because he has a bone defect in pelvis. Doctor wants to fill the defect with synthetic material. We reviewed your health plan policy for those materials. We asked your doctor for records and notes. Based on available information the material your doctor requested for procedure would not considered safe and effective for this condition. For that reason this is not a covered benefit under health plan"
What, it's bad enough that this decision is factually inaccurate, but they INSULT MY INTELLIGENCE by making me read these sloppy notes written in 3rd-world broken English. I mean, come on please.
Examples of broken English from Alexander Y. Garibashvily, MD, Medical Director, Board Certified in Family Medicine.
#1 "...he has bone defect in pelvis."
Yeah, in English it's considered proper to include an article, maybe include a possessive pronoun as well. Might I suggest "... he has a bone defect in his pelvis."
#2 "Doctor wants to fill the defect with synthetic material."
Gee Wiz, Alex! More of the same with you huh? At least this time you moved things around a little bit. Let's keep the grammar train a rollin' and offer up another pronoun and an article in here as well. How about "Your doctor wants to fill the defect with a/the/this synthetic material." How's that suit you?
#3 "Based on available information the material your doctor requested for procedure would not considered safe and effective for the condition."
I could go on and on that this statement is factually incorrect and in fact total and utter BS. However, I can't get to that yet, Alex buddy, before I take you to task for really just screwing up this whole sentence. Next time, put down the crack pipe and consider rephrasing your nonsense with something like this, "Based on information available to us, the material that your doctor referenced and requested to use for the common bone graft procedure, which has been in use for decades and is commonly called "bone cement" (and it even has it's own Wikipedia page), is not considered safe and effective for the condition."
Just FYI, they're United Healthcare. And they suck.
So, he's been in pain for like 18 months. They found a large bone cyst and no one would touch it except for a pediatric orthopedic oncologist, literally the regular orthopedic physicians would not see him, said he had to go to the super double specialist.
Total claim for everything including surgery and hospital stay was just a hair under $50k.
Now, United Healthcare is saying that the procedure was not medically necessary.
Really? Treating a bone cyst with a material that's been in use for 50 years is not medically necessary? Just crazy. Making me very upset at them.
- - - Updated - - -
United Healthcare Services letter to us.
The introduction starts off .... "Based on the information submitted, we have determined that the requested service(s) is/are not medically necessary."
Then I guess they have an MD review all of this. This guy is (I guess) Alexander Y. Garibashvily, MD, Medical Director, Board Certified in Family Medicine. However, if they didn't make this so difficult for us, it would be comical because he's clearly using some type of voice transcription device that can't hide his broken English.
I'm imagining a thick Russian accent.
"Your doctor plans a special procedure for your son. This is because he has a bone defect in pelvis. Doctor wants to fill the defect with synthetic material. We reviewed your health plan policy for those materials. We asked your doctor for records and notes. Based on available information the material your doctor requested for procedure would not considered safe and effective for this condition. For that reason this is not a covered benefit under health plan"
What, it's bad enough that this decision is factually inaccurate, but they INSULT MY INTELLIGENCE by making me read these sloppy notes written in 3rd-world broken English. I mean, come on please.
Examples of broken English from Alexander Y. Garibashvily, MD, Medical Director, Board Certified in Family Medicine.
#1 "...he has bone defect in pelvis."
Yeah, in English it's considered proper to include an article, maybe include a possessive pronoun as well. Might I suggest "... he has a bone defect in his pelvis."
#2 "Doctor wants to fill the defect with synthetic material."
Gee Wiz, Alex! More of the same with you huh? At least this time you moved things around a little bit. Let's keep the grammar train a rollin' and offer up another pronoun and an article in here as well. How about "Your doctor wants to fill the defect with a/the/this synthetic material." How's that suit you?
#3 "Based on available information the material your doctor requested for procedure would not considered safe and effective for the condition."
I could go on and on that this statement is factually incorrect and in fact total and utter BS. However, I can't get to that yet, Alex buddy, before I take you to task for really just screwing up this whole sentence. Next time, put down the crack pipe and consider rephrasing your nonsense with something like this, "Based on information available to us, the material that your doctor referenced and requested to use for the common bone graft procedure, which has been in use for decades and is commonly called "bone cement" (and it even has it's own Wikipedia page), is not considered safe and effective for the condition."
