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<b>This just makes me so mad. United Health Care refuses to pay for my DS's speech therapy too. We're hoping a DX will fix it. Thankfully it's not a life or death or physically limiting issue.<br>
Anyway this email was forwarded to me from my friend Melissa. She went to school with the Damon and Melissa.</b><br><br>
From the home of Damon and Melissa Fliegel:<br><br><br><br>
They are your life, your love, your heart. You would do anything to insure the well being of your child or grandchild. Even if that means walking to the ends of the earth. But what do you do when you’re fighting the mighty United Healthcare to give your child/grandchild the care they need. You feel so helpless when you receive those “denial” letters saying your precious angel cannot have their surgery.<br><br><br><br>
Lauren Ashley Fliegel, our 2 year old bundle of laughter and love, was born November 18, 2005 with Congenital Short Femur with extensive hip deformities. Congenital Short Femur, otherwise known as PFFD, is a condition in which the femur bone has a deficiency in growth and the head of the femur is at an incorrect angle into the hip socket. This deficiency gets larger with growth over the years of child development. As you can see in the attached picture, Lauren’s right leg is shorter than her left leg by approximately 2 ¾ inches currently (at birth it was 1 ¾ inch difference and if no treatment were provided, at full maturity there would be a 7 inch difference between the length of her legs). To date, this hasn’t slowed our sweetie down. She runs along with her limp (when not wearing lifted tennis shoe) as fast as can be, looking like a ballerina standing on the tip toe of her right foot. Unfortunately, if she does not receive the necessary surgeries to correct her deformities, this “ballerina tip toe technique” will no longer be the simple answer. Lauren needs to have, in technical terms, a “Super Hip/Knee” surgery to begin treatment. This is one operation combining multiple surgeries to correct her femur head, femur shaft angle, hip socket, knee, ligaments, and more, all in preparation of lengthening her femur bone.<br><br><br><br>
We were fortunate enough to find Dr. Dror Paley, MD. , Director of the Rubin Institute of Advanced Orthopedics/ Limb Lengthening Institute. He is THE most experienced surgeon in the world in treating Congenital Short Femur. He has been on Oprah, Inside Edition and other known programs with his advances in limb lengthening. We’ve been seeing Dr. Paley since Lauren was 9 months old. We were happy to discover that Dr. Paley is “in network” on our Choice Plus PPO Health Insurance through United Healthcare. We have flown with Lauren to Baltimore, MD twice to date to meet with Dr. Paley. At our last appointment in October, 2007, we arranged our daughter’s first surgery, Super Hip Surgery, to be scheduled January 16th, 2008. United Healthcare (hereafter referred to as UHC) provided Dr. Paley’s office with an authorization number to move forward with surgery in December. January 8th, 2008, 5 days before we were scheduled to fly to Baltimore, we received an insurance denial letter stating that Lauren’s surgery was considered an “Unproven Service”. Shock, horror, fear, sadness, every emotion ran through us like a lightning bolt. We contacted Dr. Paley via email in panic. He responded with reassurance that we would begin appeal the next business day. We were contacted, Wednesday January 9th, by doctor Paley’s office to inform us a review had been set up (peer to peer review) with Dr. Paley and a doctor on the review board of UHC. The review call took place on or about Thursday January 10th and the denial of Lauren’s surgery remained unchanged. The doctor that spoke with Dr. Paley saw no reason why the surgery shouldn’t be approved, so this gave us hope that once they received further literature being sent by Dr. Paley’s office, this would clear the situation up and we could proceed with Lauren’s treatment. However, Monday, January 14th, we received a phone call from Dr. Paley informing us that he had spoken to an “independent” review physician who had been assigned by UHC to review the case. This doctor too agreed it should be approved, and further concluded that Dr. Paley’s treatment plan was the best course for Lauren’s condition. However, the physician informed Dr. Paley that he cannot make “recommendation” to UHC as to his professional opinion, that he can only make determination whether or not the surgery could be classified as “unproven service” based on the guidelines of UHC’s policy. Furthermore, this doctor stated that based on the guidelines of UHC’s policy, nearly 99% of ALL surgeries performed in hospitals across the US could technically fall under this “unproven services” rule. Even more frustrating, is that we have made contact with others whom have had this surgery paid for by UHC, for the exact same condition, with Dr. Paley. Many of you may be familiar with a recent case of a 17 year old girl losing her life due to a delayed liver transplant approval from her insurance company. Her insurance company denied her liver transplant based on the procedure being an “unproven service” as well. After much media attention and patient outcry, her insurance company reversed her denial 1 week later, however she lost her life just hours after the approval came in. In the case of our daughter, Lauren Ashley, she is not going to die without this surgery. However, her hopes of doing all of the little things that require 2 legs, that we all take for granted, will die.<br><br><br><br>
So here we are, 2 loving parents, reaching out to anyone who will listen, in hopes that someone can make a difference. That someone may not be you, or someone you know, but rather a friend of a friend of a friend, etc. We ask that you forward this to ALL of your contacts, with the hope that it will reach someone who can make a difference. You can make the difference by forwarding our information on.<br><br><br><br>
If you have received this email and do not know how to help, the answer is to then forward it to every contact you have. Remember, all of your contacts will forward it to their contacts. If you can offer some advice, we ask that you please contact us via our information below. If you feel hesitant at all, please look at the attached pictures of Lauren. She will inevitably warm your heart and make you smile.<br><br><br><br>
Thankfully,<br><br><br><br>
Damon and Melissa Fliegel<br><br><a href="mailto:[email protected]">[email protected]</a><br><br>
ETA I didn't attach the pictures from the original email. Sorry.
 

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That's just ridiculous! Ugh, I hate insurance companies sometimes. We're blessed with medicaid at current, but I dread the day DH finishes school and we don't qualify anymore. With DD's issues, I dobn't have to fight for her formula to be provided, and I actually have gotten better treatment then a lot of private insurances. Could they apply for SSI Disability for the little girl thereby getting her additional insurance coverage? I mean thats certainly an impairment in functioning whether or not she's great at dealing with it!
 

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Insurance companies seem to have only word in their vocabulary: DENY. Your friend's story is very sad. I don't understand insurance companies at all.<br><br>
We have been covered for services that are suddenly denied for no identifiable reasons. I hope your able to get his ST covered soon.
 

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So my understanding was that most people who get transplants, even from living donors, qualify for medicaid...which often pays for much more than your avg private ins.<br><br>
Also, they need to appeal through their place of business that supplies the insurance. It is the place of business that should be pressed to force UHC's hand.
 
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