Wednesday, April 23 2014, 09:23 AM MDT
Woman Pre-Approved For Surgery, But Insurance Company Won't Pay
By Matt Gephardt
(KUTV) In 2002, Meagan Kennedy took a nasty fall.
“I fell down the stairs carrying a load of laundry down the stairs and it dislocated my left shoulder,” she said.
Meagan was able to pop the shoulder back into place, but she says that it was not the same.
“It hurts bad,” she said.
Meagan's doctor recommended an expensive surgery to fix the shoulder. To be certain the cost would be covered by her insurance company, Meagan and her husband Michael insisted that the surgery be pre-approved by United Healthcare even getting a confirmation number.
For a year and a half after the surgery, everything seemed fine until a letter arrived from United Healthcare. It said that at some point after the surgery, the clinic where Meagan had it was deemed not to be in United Healthcare's network. United Healthcare took the money back from the clinic leaving Meagan and Michael owing more than $10,000.
“I feel like it's unfair,” Meagan said.
Meagan and Michael went through all of the various levels within the insurance company, appealing three different times. But the decision did not change. So this time they appealed all the way to the U.S. Department of Labor, which oversees certain insurance companies. The agency sent a letter to United Healthcare demanding they pay, writing, "it is unlawful to punish the participant for [united healthcare's] error." Still, United Healthcare refuses to budge.
Meagan and Michael decided to Get Gephardt.
So, this time, we called United Healthcare on Meagan and Michael's behalf, not through customer service but through their corporate communications department. United Healthcare didn't want to talk on camera but a few days later they issued a statement saying, “After, further review, it was determined that the Kennedy family was given incorrect information. Mr Kennedy will not be responsible for any of the bills received.”
And just like that, the bill United Healthcare had promised to pay in the very beginning was finally paid. It only took two years, three appeals, a letter from the feds and a call to a TV station to get it done.
If there is a lesson to be learned from all of this, it's keep diligent notes and paperwork and get a confirmation number for pre-approved procedures.
(Copyright 2013 Sinclair Broadcasting Group)