r/WhatIsTheTea • u/Ashish_ank What the Fuck • 5d ago
watch this A 25-year-old suffered a catastrophic brain injury in a motorcycle crash and UnitedHealthcare is REFUSING to pay for the treatment that could help him wake up...
...because they decided it was "NOT MEDICALLY NECESSARY" even though his doctor's said it was!!!
His name is Peyton Alvarez, he's 25 years old.
Back in April, Peyton was riding his motorcycle near Greenville, South Carolina, when he veered off the road and hit a tree.
He was wearing his helmet, but. the impact left him with a traumatic brain injury so severe that doctors call his condition a "disorder of consciousness."
His mother Trina got the call every parent on earth prays they never get. "We have your son Peyton, and he's been in a motorcycle accident."
There is a place that specializes in bringing people like Peyton back. The Shepherd Center in Atlanta, one of the best brain injury rehab centers in the country.
And it wasn't just his family who wanted him there. His DOCTORS recommended it.
The people who actually examined Peyton said this is the care he needs to recover.
And UnitedHealthcare said NO.
Their reason, in writing:
Peyton's condition "does not meet the criteria" for the rehab his family requested.
In plain English? They called the treatment that could help this young man wake up "not medically necessary."
Not one person at that insurance company has ever laid eyes on Peyton. His doctors have, but UnitedHealthcare overrode them anyway.
Instead, they offered a NURSING HOME.
Yes, you read that right... a nursing home.
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u/Rehcraeser 5d ago
that should be illegal. wtf are we paying for every month if they dont even cover basic treatment when something happens?!
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u/BraisedBullshi 5d ago
What happened to the previous United Healthcare CEO? Someone should ask him if this practice is normal for the business
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u/SirStrokesAlot247 5d ago
Insurance companies always do this. They have lists of things they don’t cover. Like, why is there a whole list of exclusions? What are we paying for? SMH. It might as well be a scam.
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u/KittyandPuppyMama 4d ago
It is a scam. We should all collectively band together and drop our policies. They’d be out of business overnight. But we can’t stop arguing with each other long enough to see who the real enemies are.
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u/hawksbears82 5d ago
I see what you did there
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u/PeskyAntagonist 5d ago
They sure got those flock cameras up in a hurry after that little speed bump didn't they
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u/jhawk3205 5d ago
It makes more and more sense that Medicare for all is getting more traction with the public, to the point where Trump is even addressing it.. Like, how bad is the existing system going to get and why are those in power so willing to risk losing elections, get assassinated, etc over simply joining the rest of the developed world?
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u/exqueezemenow 5d ago
The goal is to make them a lot of money, not save lives. Otherwise we would just have universal healthcare.
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u/Societyman1878 5d ago
And the thing is that they would still make a shit ton of money even with universal healthcare. The greed is astonishing.
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u/rrtccp1103 5d ago
This. There are countries that allow insurance companies to operate. They aren’t allow to deny healthcare. They still make a TON OF MONEY. Just less than the US. This is all a sick fucking joke
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u/jarena009 5d ago
Their business model is predicated on denying care. They only profit if they deny enough healthcare.
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u/Fabulous_Jeweler2732 5d ago
We can make this illegal is we push politicians. It’s about time, and would solve a lot of problems.
A lot of people are suggesting a law that makes it illegal for insurance companies to deny doctor recommended treatments.
Physicians are the authority, not insurance.
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u/annacat1331 5d ago
Well united healthcare told me to use a tampon and maxi pad in/over my gaping surgical wound because they denied covering a wound vac for a few weeks. It wasn’t like it was right above my heart or that I had gone septic and the infection had eaten up into my carotid artery or anything… oh wait
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u/Babybleu42 5d ago
That is how all insurance is.
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u/4thkindexperience 5d ago
It's a scam.
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u/Babybleu42 5d ago
It is. And the government makes us buy it. At least car insurance anyway.
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u/8amteetime 5d ago
The government is run by politicians who need money to run for office. That money is donated to them by the insurance industry.
See how the American system of government works?
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u/Senior-Friend-6414 5d ago
Yeh everybody already knows insurance companies are one of the most exploitative industries to ever exist
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u/P00rSuggestions 5d ago
Again then, WHY THE FUCK ARE WE PAYING FOR IT IF IT DOESN'T COVER ANYTHING ANYWAY!?
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u/Babybleu42 5d ago
Because we’re too stupid to vote for someone who will just give us universal healthcare. 🤷♀️
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u/Previous-Whereas9268 5d ago
I'm pretty sure they would just kill that person if we voted for them lol.
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u/theskysthelimit000 5d ago
"ThAtS sOcIaLiSm"
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u/Babybleu42 5d ago
As long as our government keeps telling us that. As we watch all other first world countries get healthcare without bankruptcy 🤦♀️
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u/jarena009 5d ago
Welcome to good old for profit health insurance in the US. Pay in tens of thousands per year in premiums, then when something goes wrong, they deny your claims, and the insurance isn't there.
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u/Angie_T84 5d ago
Last quarter (3 months) united Healthcare reported a record $14.3 +million in profits, and also denied 1 in every 3 prior authorization requests for people that have paid monthly. It's all a scam and we are the lil worker bees. Privately owned state penitentiary, Healthcare, freedom alllll a lie . Hope they hook me up to the matrix soon if they haven't already 😆
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u/OneLessDay517 4d ago
What this article is talking about is NOT "basic treatment". At least be honest about that.
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5d ago
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u/broketothebone 5d ago edited 4d ago
We are currently fundraising for my friend who is a 40 year old man recently diagnosed with cancer. Luckily, he’s beloved in the scene here and we raised a lot for him to move forward out of pocket. He thought he had incredible insurance until he overheard his doctor screaming at them on the phone that he knew they were “just trying to run out the clock again.” It’s that “again” that scared the shit out of us.
They said they could approve tests until they knew what stage he’s at….which they can’t determine without those tests being approved. Doctors know it’s in his lymph nodes somehow (forgive me, I might be messing up details), and are worried about where else it could be. Insurance turned down basic CAT scans, to the point he considered breaking his own bone just to get one. He works for my bf, where he gets his insurance, so now my boyfriend is on the phone with them like “wtf are we paying you for” and they advised him to reduce his friends hours to end his coverage. Basically just advised him to help them let his friend die. We’re so angry, it’s sickening.
Needless to say, we’re big Luigi fans over here.
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u/shann0n420 5d ago
How are they not liable for the deaths of all of these people they’ve refused care to?! This is so absolutely insane.
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u/WheresYurScooter 5d ago
Oh wow, that’s awful. I’m proud of you guys for fundraising on his behalf ❤️
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u/broketothebone 4d ago
Thank you. He’s earned it just by being the best dude you could ask for in your life.
If he has one day off in a month and you need help moving, guess who shows up with his truck and some bagels? That guy.
It just shouldn’t have to fall to the community to save our friend when he has money taken from his paycheck to do exactly that. It’s so obviously broken and the government’s “solutions” are just spitting in our faces.
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u/TheNatural14063 5d ago
What's the name of the health insurance company and CEO responsible? Public should know
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u/JeromeBarkly 5d ago
Reminds me of my two stints in rehab. It was a daily battle with insurance companies to not get booted out into an out patient program.
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u/-laughingfox 5d ago
Especially egregious...I can't imagine that kind of stress is helpful to people struggling with sobriety.
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u/KittyandPuppyMama 4d ago
It’s so eye opening. My MIL damaged her knee while on vacation in Japan. Paramedics had to carry her down several flights of stairs because the building where she was staying didn’t have an elevator. They took her to the hospital in an ambulance and gave her an X-Ray. The total cost was $100 and that’s only because we bought a cane at the hospital. And the hospital apologized to us for the expense since we don’t have insurance they would accept.
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u/Yaya_Tovar 5d ago
This is what makes the USA a third world country
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u/Zv_- 5d ago
American here. Fuck this goddamn place, I’m moving to Canada the first chance I get
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u/TerninoMarchi 5d ago
Word. A third word country attacking multiple other countries with bombs to export their idea of democracy. What a joke.
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u/BrockObarnerLybian 5d ago
Nobody is even pretending we’re exporting democracy anymore lol
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u/Whydoialwaysdothis69 5d ago
This is the reality that most Americans don’t realize until it’s too late. No one sees it because people with money don’t live this same reality.
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u/Radcouponking 5d ago
This evil system costs the government MORE than universal healthcare would but we do it anyway because shareholders.
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u/modsurfer0303 5d ago
Time to call Luigi….. set things right.
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u/Cultural_Eye5178 5d ago
Nah, Luigi's not home. Try Mario's cell instead.
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u/AnyUnderstanding1879 5d ago
I've heard he's a good plumber, capable of dealing with shit
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u/Cultural_Eye5178 5d ago
Yeah, I've heard he's one of the top leak-stoppers that has ever existed.
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u/hellllllsssyeah 5d ago
with the level of villainy and monsters we need Samus .
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u/Cultural_Eye5178 5d ago
Somebody call Doomguy
We need to,,,,
rip and tear
the healthcare and insurance system apart
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u/Rampantcolt 5d ago
Sounds like it's time for another mangione.
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u/broketothebone 5d ago
Kind of amazed no one else has done it since.
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u/bendap 5d ago
I do think that was a missed opportunity for a turning point. If someone else acted within months of Luigi it could've been a catalyst. That's easy to say though. I wouldnt put everything on the line like Luigi.
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u/Ecstatic-Time-3838 5d ago
Our 13-month old son needed brain surgery to remove a tumor that was causing him to have seizures. He would just stop breathing.
United Healthcare fought the surgery until the night before, almost 12 hours prior to the surgery. The surgeon even called the insurance company herself to essentially beg them to let her do the surgery.
Insurance companies are scummy, evil, greedy entities.
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u/M03KE 5d ago
I’m so sorry. I hope your baby is doing better now.
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u/Ecstatic-Time-3838 5d ago
Thank you! His surgery went well and he has made a full recovery. Will be 18 months in a few days. Tumor was fortunately benign, so we just have to go in for and mri every three months.
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u/heady-luvare 5d ago
I payed into united for 10 years and they refused to pay for an mri for my back after an xray showed i had a deformed L2 vertebrae. They immediately set up an mri appt after the xray and when came time i talked to mri place they said United had me down for self pay for it. They flat refused it even though it was needed. Ive had all kinds of issues since. My body is falling apart. They only would pay for enough of my psoriasis medicine to last half a month. Was on my own other half. Fuck United
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u/Sistahmelz 5d ago
Of course they are refusing to pay. The CEO needs the money for his $20 million paycheck or however much it really is. How else will the company pay him? /s
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u/Desperate_Trifle_202 5d ago
so why are we paying for insurance? seriously...
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u/Kindly_Coyote 5d ago
Because there are Congress members who are stockholders in the healthcare industry.
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u/Various_Candidate499 5d ago
I mean look, even considering this from a cynical financial standpoint which is the way insurance companies view things I imagine it would be less expensive to try a treatment than it is to put this fellow in a nursing home assisted living situation for what could possibly be 40 years.
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u/emperorpeterr 5d ago edited 5d ago
Hospitals need to have a legal obligation to perform the surgery treatment anyway. They already have a legal obligation to perform emergency surgery regardless of a patient’s ability to pay, per EMTALA, but this needs to extend beyond just stabilization.
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u/Kaltovar 5d ago
I would argue that if you're not treating a cancer patient you aren't stabilizing them. They're manifestly deteriorating and will die. That's not stable.
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u/skintightmonopoly 5d ago
Not shocked. My partner underwent surgery to remove a 7 cm tumor in his spinal column. Insurance approved the removal of the tumor but denied the second half of the surgery to close up his spine. They are soulless.
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u/aliencardboard 5d ago
The more you hear this stuff, the more I don’t care what the Luigi guy did. Healthcare insurance in America is basically legalized crime.
For all of the morons who call socialism communism; read a book and learn the difference. As long as we have far right lunatics who enjoy struggling and seeing people poor and paying ridiculous amounts for medical care then nothing will change.
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u/nebraska_jones_ 5d ago
Anyone that works for United Healthcare in any capacity is complicit in keeping the company running and should be ashamed. That’s from the CEO to the lawyers to the pencil pushers to the secretaries. We as ordinary people have the capacity to bankrupt and end companies like this if we just refuse to work for them.
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u/TerninoMarchi 5d ago
When are we going to at the very least normalize blasting the names of each person responsible for these cases on every media available? I refuse to believe they wouldn't be shunned out of existence if their faces were publicly associated with these stories. We have to rehabilitate public humiliation. Imagine going to church with grandma and having to explain why you chose to work for a company like that.
The free USA seems such a cage when watching from abroad, really. WTF of a system have you created for yourselves.
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u/DrowningInFeces 5d ago
They don't want to set a precedent of actually helping people who need healthcare despite being a $1.7 trillion industry. Clearly, the insurance companies need the money more than giving people the money they need to not die.
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u/GetItOuttaHereee 5d ago
My dad had colon cancer and we found out when he was pooping blood. He lost consciousness in the ER waiting room before he could check in. They rushed him back and gave him a blood transfusion and admitted him to ICU. The insurance tried to say they wouldn’t pay for it because it wasn’t medically necessary. So I believe it.
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u/Much-Chapter5527 5d ago
I'm a doctor and this is getting worse. Seeing SNF being referred to as a "middle ground" is just plain an insult to injury to a family who essentially lost their son, who otherwise had a whole life ahead of him. Essentially a death sentence.
Imagine this happening while these companies celebrate record profit quarter after quarter. Just picture that there are people who benefit the most monetarily over these denials who are far enough removed that they pop champagne and tell you flat in the face that American healthcare system is working just fine.
Just ask why do people have to set up a go fund me on top of their insurance? We're already in a dystopian society
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u/Gooser3000 5d ago
We just need to all cancel our coverage. Then, maybe a mass worker strike and boycott of nonessential spending. We would get any demand in weeks. Otherwise, as long as we keep paying and working, nothing will change.
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u/Skailon 5d ago
It is interesting. When a Black repeat offender died during arrest due to police brutality, your entire country split apart, and mass protests began with the slogan “Black Lives Matter.” But when an ordinary law‑abiding citizen dies because the bastards at the insurance company decided not to spend money, nothing happens. No outrage. Only one person decided to take action and shot the CEO and that didn’t change anything.
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u/MathematicianAfter57 5d ago
remember united turned down about 1 of every 3 claims they got last year
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u/vixenhotwife20 5d ago
This happened to my wife she ended up with the same exact injury and diagnosis. We contacted Shirley Ryan Ability Lab in Chicago as they are the true number 1 place in the country for getting people back from severe TBI. They actually handled all the insurance work and even got her med flighted from Florida via a med jet as she was unconscious still at that point. From 2 months in a coma once she reached Shirley Ryan within 2 months she was walking talking and living and released!! Still a life long recovery but you need to push back at the insurance companies and sometimes the hospitals can handle it for you. Nursing homes are were peopel goto die not to recover!!
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u/ealysillyforestthing 5d ago
Only developed country in the world that it's like this.
Money enough for bombs but not for healthcare.
Fun fact, it would be cheaper to do away with the middleman and do single payer
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u/Eponymous-Username 5d ago
What happened to their last CEO? Seems like there's a moral imperative for them to learn from that episode, if nothing else.
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u/BODO1016 5d ago
If I was the insurance company, I’d be very worried right now for declining this necessary treatment
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u/JasonGrapes4119 4d ago
Thays the CEO that Mangioni shot for denying his families life saving care. Once I heard united Healthcare i was like oh the company that will let you die. ...
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u/Animal907 4d ago
Alot of people who have United Healthcare are on Medicaid because they can not afford healthcare. Imagine someone saying they'll help you to a point, but won't finish the job. That's the state and Federal government doing this! Expand Medicaid because it's essentially Universal Healthcare. The recent call to expand the 65 and older system Medicare is just another political red herring. Give Americans entitlements so they will have the right to healthcare in America.
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u/fatman194569 5d ago
No matter how any moron tries to demonize him. Luigi is a hero, killing a murderer who's gotten away with killing for decades just because he's rich
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u/Aegoe 5d ago
Psychotic patient of mine could only function in society (ie: continue in school, maintain a job) with Abilify Maintena, an injectable that releases the antipsychotic medication over an entire month.
This was important, because when his paranoia flared up he was too suspicious of his oral Abilify to take it consistently, thus hurdling him deeper into psychosis. The injection worked EXTRAORDINARILY WELL. Typically, my schizoaffective patients never even responded THAT well to antipsychotics, but this man was a true responder.
It’s a shame that the longer someone spends in psychosis, the less likely it is that they will ever return to their original baseline. I don’t know the science behind it, but time in psychosis appears to do considerable damage to the mind.
I sent doctor’s notes specifically mentioning that the injectable was the ONLY option. NOTHING else would work due to ineffectiveness or due to the nature of his psychosis.
Denied. “Try orals again,” despite multiple trips to inpatient treatment resulting in failure outside of the injectable in question.
He’s fucked. His brain is fucked. Each day that family fights for his mental health is a day lost and an extra day’s worth of damage to his mind.
That’s why, as a nurse, I didn’t blink when the famous plumber’s brother payed a harsh visit.
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u/Hot-Cauliflower-1604 5d ago
My dad died of cancer because of this and like we did everything we could. We just still got f***** by the insurance companies when they just said yeah we can't support you anymore and then he died. I hate them. I HATE them.
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u/Mercury8619 5d ago
This is a shining example of how shitty the "medical system" is in good ole USA. It shouldn't ever be about money. It should be about saving lives and not monopolizing off of the illness & misfortune of others. It is the most corrupt system in existence and honestly we should have fought hard to rip it out ages ago. Health insurance companies need to be banned.
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u/YakFun1785 5d ago
When they said "Not nessesary" they didn't talk about the patient.
Serious, US nowaday feel like you guys are living in a special kind of Hell or something.
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u/Chunkycheesesteak 5d ago
So....if we don't have insurance,we're fucked trying to pay anything out of pocket & 9xs out of 10 denied surgery or anything that'll help right off the bat.But if we do have insurance; well .. 🤦🏽♀️
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u/peterjohnvernon936 5d ago
If you have private healthcare insurance, you don’t have healthcare, you have a monthly bill. Until they are stopped, the CEO will one up each other for the percentage of treatments denied until no one gets treated.
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u/Status-Pea-5492 5d ago
A Lancet Public Health study estimated that about 27% of U.S. healthcare spending, roughly $730 billion, was attributable to modifiable risk factors like obesity, high blood pressure, high blood sugar, poor diet and smoking.
Adherence to recommended lifestyle changes is pretty low. A recent meta-analysis of people with hypertension found only 27% overall adherence to lifestyle recommendations. Only about 34% met exercise recommendations, 27% met weight-management recommendations and 48% followed dietary recommendations.
Patient behavior is a pretty significant part of the healthcare cost discussion.
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u/b3dGameArt 5d ago
They profited $5.5 billion by denying claims like this and thats only the 2nd quarter. And they wonder why theyre CEO became a target. We need a 1000 more Luigie's. Corrupt fucking companies.
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u/Chanmani38 5d ago
There’s a reason why the CEO got cooked in front of the Hilton…..don’t condone violence but I understand
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u/WindowOtherwise7793 5d ago
That is some fk bullshit. Do a go fund me!!! They raise a million bucks for a murderer and some racists. For a good cause you can probably get good money to help him. I'll donate.
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u/solarpropietor 5d ago
This story should play at Luigi’s trial, as mitigating circumstances.
United healthcare executive board is guilty murders that amount to a small genocide.
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u/Haunting-Respect-375 5d ago
I plan on just committing suicide if I get any health issue too serious. I won't be able to afford it. I've been looking forward to dying for a long time anyways
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u/whoknewidlikeit 5d ago
today got a notice about a patient on a referral.
United Healthcare has decided it's not enough for an internist to refer a patient to a dermatologist for a skin mass that looks cancerous... now i have to sign up through their online portal to enter a referral on their platform and beg for a referral. in addition to the 60 hours i already work a week.
this is only for one reason IMO - to delay referrals and increase quarterly profits.
if you have a choice, consider policies not supported by united and cigna. based on my experience they are the most likely to use tactics like this.
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u/Aware-Ad-3735 5d ago
they are killing us, but any action taken against our death is seen as violent and barbaric and wrong, smh
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u/CaterpillarDizzy3014 5d ago
Normalize suing their ass at the slightest inconvenience - let alone something as bizarre as this. Atp they’re robbing Americans in broad daylight.
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u/nurseferatou 5d ago
Insurance companies try to get away with diabolical shit like this every hour of every day in America.
Blue Cross Blue Shield tried to deny one of my patients paraplegia rehab, because, and I’m not fucking kidding here “they won’t be able to use their lower extremities and therefore won’t qualify for plate rehab”.
Turned out, it was that their human who reviews their AI claims slop, didn’t realize that their slop was slop and not a prudent medical decision.
The AI bubble can’t pop soon enough.
Edit to add: to be clear, they’ll still try to pull heinous stunts like this constantly, they just won’t be able to hide behind enshittified AI slop.
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u/Chaos_Theory1989 5d ago
I’ve been having health issues ever since I had my daughter, some of them life-threatening. Every single office visit has been denied even though it is in network. It is not covered by my insurance so, I don’t know what the fuck insurance is even for.
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u/czaranthony117 5d ago
I’m old enough to remember 2009 when politicians that didn’t want Single Payer Healthcare saying that we would have “government panels that will decide your care.”
Now we get private conglomerates doing this.
Our healthcare system is not a free market system… it’s all a corporate farce.
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u/Fabulous_Jeweler2732 5d ago
We can make this illegal is we push politicians. It’s about time, and would solve a lot of problems.
A lot of people are suggesting a law that makes it illegal for insurance companies to deny doctors recommendations.
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u/Ok_Blacksmith_3030 5d ago
Our healthcare system is the most expensive in the world and delivers mediocre outcomes and many medical bankruptcies. Medicare-for-all is long overdue. Screw the blood sucking insurance companies.
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u/ineedadayjob 5d ago
Society in US is about ready to blow. Something like insurance industry, political corruption, stock market crash or AI collapse. It's coming.
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u/Initial-Ostrich-1526 5d ago
This has been going onnfor ever. We have had to get senators to intervene. Insurance is criminal, simple fact is thier biggest profit comes when you pay when healthy and then die. They have no interest in keeping someone with chronic conditions alive every day a sick person lives is a net loss for them. They are incentivized to keep you healthy with preventative medicine yes. But, once sick they incentive is a quick death.
And weather we want to admit it or not we get what we incentivize.
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u/Upup-andaway965 5d ago
This hurts my soul. Makes me think of whether I want to have and raise kids here in America. I wouldn’t want to subject them to this hard American life.
Definitely researching other countries to settle in.
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u/RaiderFred 5d ago
Well, yeah, there is very little money in the cure. Ya make your money on drawing it out and keeping him in a coma. Business decision. We are being farmed for profit.
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u/CommercialAgency928 5d ago
BuT tHe HeAlTh CaRe In CaNaDa Is TeRrIbLe!!!!
Fuck anybody and everybody who defends the US healthcare system.
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u/pokemonandcatsz 5d ago
If it wasnt for the American Helathcare System id have a home, wife, and kids. Instead of constantly fighting to survive for life saving meds. Its literally easier for me to broke and get government assistance for my meds but how is that a way to live. The system is beyond cracked. For those wondering i make like 50k a year ish. But factor in cost of living, food, 500x12 for heslcare a month which doesn't include co pays or deductibles.
Its no wonder bullets are looking for appealing to everyone. We are all indentured servitude, just some of us are too ignorant too acknowledge it, and saddest most fucked up part is majority of us know it, and do nothing.
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