As some of you may recall, I was hospitalized last month due to a hemorrhage. United Healthcare has denied coverage of my hospitalization. Let me know if you think this was written by Artificial Intelligence (A.I.).
Here’s what they sent:
Date(s) determined not to be medically necessary: 07/11/2023-07/12/2023
The clinical reason for our determination is: You were admitted to the hospital on 7/11/2023. The reason is you had blood in your stool. We read the medical records given to us. We read the guidelines for a hospital stay. This stay does not meet the guidelines. You did not have to be admitted as an inpatient in the hospital for this care. The reason is you were watched closely in the hospital. You did not have a severe illness. You were stable. You had tests that did not show any problems that needed inpatient only treatment. The records showed you did not need a transfusion of blood products. You could have gotten the care you needed without being admitted inpatient at the hospital. The hospital inpatient admission is not covered. We let the hospital know that it is not covered.
Here’s my response:
August 3, 2023
United Healthcare Appeals Unit
P.O. Box 30573
Salt Lake City, UT 84130-0573
This letter serves to formally appeal UHC’s decision to deny coverage for my recent hospitalization. The UHC letter described my condition as “blood in the stool.” I did not have “blood in the stool.” I was severely hemorrhaging.
I am a carrier for Von Willebrand disease, which is a bleeding disorder. It prevents my blood from clotting properly. I have had bleeding issues for years, which have been documented by United Healthcare because UHC has been my insurance company for more than 13 years. I have been hospitalized for bleeding before. When a person with this condition hemorrhages, it can be fatal. People who have this disorder, and who are hemorrhaging, don’t get released from hospitals. They get admitted.
On July 10th of this year, I was transported by ambulance to Chattanooga Memorial Hospital due to a hemorrhaging incident. I sat on the toilet at home, and was shocked when copious amounts of blood and clots poured out of me. I was not in any pain at all. It came without warning. I called 9-1-1, and sat on the toilet while waiting for the ambulance. And, it happened again, and again, and again. I was hemorrhaging BADLY.
In the ambulance, my blood pressure and pulse were high and I was tachycardic.
Once we arrived at the hospital, I was immediately taken to a room in the ER. A sample was given (approximately half a cup of blood and clots that had been building up inside of me in the ambulance), they took blood for several tests, typed my blood in case I’d need a transfusion, and put a red bracelet on me for the blood bank. I also had a CT scan of my abdomen. I was losing so much so fast that they brought a portable toilet into my room because I’d left blood on the toilet and on the floor in the bathroom in the hallway. I had blood on my legs, my dress, and my hands. The nurse accidentally spilled one of my “samples” (from the portable toilet) on the floor and it looked like a murder scene.
I am enclosing a picture of just one sample of blood that would come out each time I sat on the toilet. I know you will agree that this is a startling amount, and that no hospital should send a patient home who is experiencing this much blood loss every 10 to 15 minutes. Especially a patient with a bleeding disorder. Yet, according to UHC’s letter, I should not have been “admitted.”
The CT scan could not confirm the source of the bleed but, due to my symptoms and because of the diverticula seen on the scan, a diverticula bleed was suspected. A diverticula bleed is when a small artery located within a diverticulum is eroded and bleeds into the colon. The situation is painless and I was still not experiencing any pain. However, it can be fatal, especially for patients like me.
After several hours in the E.R., I was still bleeding heavily and, as you can imagine, I was still terrified! The only way to confirm the preliminary diagnosis would be through a colonoscopy. However, I had to do the prep for that first. That would take hours. And, I was still losing a LOT of blood.
When I arrived at the Emergency Room, my hemoglobin count was 14. On the afternoon of the 11th, I was told that it had dropped to 9.6 or 9.8 (I can’t remember which). Nursing staff advised me that they I would need a transfusion if it dropped to 7. Again, this was far more than “blood in stool.” This was a regular flow of blood, over an extended period of time.
I was, of course, admitted to the hospital (I believe it was around midnight on July 10th). When I got to my room and they moved me onto the bed, I coughed and more blood and clots poured out of me. The nurses had to change my bedding and put me in a gown.
I bled all night long, and well into the next afternoon (more than 24 hours). This was July 11, 2023, the first day UHC said I should not have been admitted to the hospital. Once the bleeding started to taper off in the late afternoon, they started the colonoscopy prep, letting me know the bleeding could get worse from it, which was alarming because I’d already lost so much blood. They monitored me during the prep because the bleeding could have gotten worse and, as you know, the prep takes 8 hours of drinking the nasty drink, and then several hours of continuing to allow your colon to “run clear.” This was the early morning hours of July 12, 2023, which your letter also stated I should not have been “admitted” for.
First thing the next morning, I had the in-patient colonoscopy. The bleeding had stopped and the hospital released me immediately after the colonoscopy.
I have now been advised by UHC that I should not have been admitted, and that UHC is unwilling to cover my treatment. That is unacceptable.
I am a business owner. I have been insuring all of my employees and their family members through United Healthcare since 2011. That’s 13 years. I pay 100% of all of my employees’ and their family members’ insurance premiums. We’ve always had excellent service from your company. We always pay our bills on time. We have kept paying, even as UCH has increased our rates significantly every single year. I kept doing it because UHC has given us such good service over the years.
No hospital would release a patient in my condition. From a liability perspective, and a life-saving perspective, no hospital or doctor would release me after seeing the amount of blood loss, and knowing about my bleeding/clotting disorder. Based on all of these facts, UHC needs to change its determination of non-coverage for in-patient services.
cc: CHI Memorial Hospital Chattanooga
NOTE TO MY READERS: I am not posting the blood picture here. It will disturb some people. If you want me to email it to you, holler at me RIGHT HERE. I will let you all know when I hear back from United Healthcare. If coverage is denied again, they’re in for a hell of a fight. Remember, I sued Amazon back in 2008 and I won.
- UnitedHealthcare Tried to Deny Coverage to a Chronically Ill Patient. He Fought Back, Exposing the Insurer’s Inner Workings.
- Why I Was Hospitalized Last Week – WARNING: GRAPHIC CONTENT
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