Monday, May 28, 2012

United Healthcare: Is This For Real???

I recently received an email with an attachment that stated that United HealthCare (UHC) is offering grants to help defer the cost of therapies and other necessities that are not covered by insurance.


So after clicking on the link and reading the site and what it has to offer, I wondered to myself if they were for real or if there are *exclusions that apply.

Apparently they have set up a foundation, which according to their website, states that "...The UnitedHealthcare Children's Foundation is a non-profit Section 501(c)(3) charity funded by contributions from UnitedHealth Group, UnitedHealthcare and its employees, as well as the generosity of individuals and corporations."


Now, I work in health care (I am a Registered Nurse) and I work alongside many professionals (doctors and Social Workers) who have a hard time getting UHC to pay for inpatient days for a patient who just had brain surgery and needs acute inpatient rehab.

And now they have a foundation?

And I am friends with many many many parents who have children with special needs and UHC will not, under any circumstance, pay for the much needed speech therapy and occupational therapy that the child desperately needs.

And now they have a foundation?

UHC states in their Philosophy that "...The Foundation embraces and supports the concept of facilitating access to health-related services that have the potential to significantly enhance either the clinical condition or the quality of life of the child and that are not fully covered by the available commercial health benefit plan. The Foundation provides financial assistance toward the family's share of the cost of medical services."

Embraces and supports the concept of facilitating access to health-related services that have the potential to significantly enhance either the clinical condition or the quality of life of the child. 
Isn't this what we want all insurance companies to do for our children?

Call me crazy, but that's what I expect from my insurance company!
I have a contract with them.
I send them money every two weeks from my paycheck.
Essentially, we have an agreement.
I pay my premiums, they pay for the services that my children need.

(NOTE:  I do not have United Healthcare as my insurance provider.  You all know who I have.  And they have been extremely good to me and my children, thank you very much!)

So how does this grant process work?

According to the UHC website, "If a grant is approved by the Regional Board of Directors for your child, the grant will help pay for approved medical services/items after your commercial health benefit plan submits payment, if any. The grant funds are not paid to you or the child outright - you work with the Foundation on submitting invoices/bills for approved medical services/items after your commercial health benefit plan submits initial payment (if any) to the health care provider..."

Ah-ha.  A Regional Board of Directors.  If UHC is reading this, could you explain who staffs this board and what their qualifications are?  Because in my experience, the people making the decisions typically are not medical professionals with specialties in the areas which services are needed.

UHC, is your RBOD staffed with Developmental Pediatricians? Speech-Language Pathologists? Occupational Therapists and Physical Therapists (licensed)?  Pediatric Neurologists? 

I did see one Registered Nurse there.  Is that all?  Only CEOs and heads of committees?  Yes, this frightens me.

I only ask these questions because there was a time when I was appealing with my own insurance company (not UHC) and they said (in writing, mind you!) that a "Board Certified Physician read my appeal and came to the decision to deny..."  Only later did I come to find out that the above said Board Certified Physician was indeed certified in Infectious Disease and was an Internal Medicine doctor.

Um, my daughter was 6 years old at the time (not an appropriate age for Internal Medicine since they deal with adults and not children and she did not have an Infectious Disease:  she has apraxia of speech, and that is not spread person-to-person like the flu or whooping cough.

Hence my concerns when reading about this so-called "Regional Board of Directors" that htey have making these decisions.

So after reading through the website, they show this nomogram on how the process works:

I also read that the maximum grant* offered is $5,000.00.

Generous, since most therapies cost upwards of $150.00/session if not more.  So in this case, I will say "thank you" for the generous offer.  But of course, on the website, they state "if a grant is awarded, grants can vary considerably."

So one might get $5, guarantee.
And that is up to whomever staffs the Regional Board of Directors.

There are
more FAQs here if you want to read them.

See for yourself.

Don't take my word for it.

Click here to go to the UHC site yourself and read all about the grants and how the application process works and how it takes 1-3 months for them to come to a decision.

It would be nice if this was the relief that so many parents are looking for.  But something tells me that there is much more than meets the eye.

Wouldn't it just be easier if insurance companies covered the habilitative therapies that our children need to bring them to a functional point in their lives that maybe, just maybe, we would not have to rely on grants?
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  1. Sound like a very cheap form of advertising for them. And a giant waste of time for the families hoping to get a grant and desperately seeking help. It seems like a cruel marketing ploy.

  2. Seems like UnitedHealth Care has a guilty conscience and rightly so. They have denied every single speech therapy for my child for the past 2 years. One UHC representative told me that speech was a luxury!?!? Really, easy for them to say that. Speech is like a Rolex, a Mercedes, or a mink coat....maybe in UHC's world, but not mine.

    UHC if you are reading this....I loathe you! You owe me and my child not only speech therapy that should be covered by our plan with you, but for the past 2 years of therapy you haven't paid for. You can continue to deny claims, but I am not going away. And no amount of grants your foundation gives away will make amends for your deals with the devil.