United Healthcare Member Inquiry/Appeals
PO Box 30432
Salt Lake City, UT 84130-0432
Dear Member Inquiry Representative;
I am writing to request a formal of review of the decision made by United Healthcare to deny my health service claim of 10/01/08 for a service already formally approved. Please see the enclosed EOBs.
My service provider, Degc Enterprises, provides me with an insulin pump delivery system to regulate my blood sugars. In-network rates and approval for this insulin delivery system were given by United Healthcare prior to 7/1/08 when the company billed United Healthcare for the first medical shipment.
Since starting the pump on that date, my A1c has improved from 6.5 to 6.1. I expect to see a further improvement at the end of December when I have my next checkup.
As a Type 1 diabetic, I cannot live without continuous insulin delivery. My condition is a genetic immune disorder, which I fully disclosed to United Healthcare through my employer. As is well known, controlled blood sugars are vital to the avoidance of complications for Type 1 diabetics.
My use of the Omnipod pump, provided by Degc Enterprises, has dramatically transformed my life. Unlike other pump systems, it has no tubing, which results in fewer accidental disconnections that could adversely affect my blood sugars. It’s these higher blood sugars which contribute to the expensive conditions diabetics are prone to – like blindness and amputation.
Initial cost of the pump is also less than that of many other brands of pump. Its ability to regulate my blood sugar with greater reliability and efficiency than other pumps also greatly reduces my risk of expensive complications. Since using this pump, I have experienced 75% fewer episodes of low blood sugar, which – if not caught in time – can often result in costly medical claims for your company.
It was for these reasons that my pump was approved and covered at an in-network rate on 7/01/08 (see attached EOB).
Until you have provided Degc Enterprises with the payment you have contracted with them to provide, they will be unable to provide me with the insulin pods which have allowed me achieve this improvement in my overall general health and quality of life. I will be forced to revert back to using vials and syringes as my insulin delivery method. This method will undoubtably result in erratic blood sugars and set me down the road, once again, to extreme – and expensive – diabetic complications.
Repeated contact with your customer service line has shown me that they have little control over the approval/denial of claims process. It is for that reason that if it becomes necessary to escalate this matter, I am fully prepared to lodge a more formal complaint with the Attorney General. If necessary, I will also recommend that my employer drop our UHC account in favor of a company more consistent in its approval process.
I am sure you understand that as a Type 1 diabetic, my life and health depend urgently on the quality of coverage and care I receive. My employer considers me a valuable asset to the company, and knows that my decision – and the decision of many of our employees – to stay on board is greatly influenced by the quality of our healthcare coverage.
Thank you so much for your attention to this matter.
Sincerely,
Kameron Hurley
(or maybe, what we really need to improve America’s health is a “fat tax”. That would be so much easier than universal health coverage that works. I’m sure it would be just as good as real healthcare. After all, we wouldn’t know the difference)
