r/HealthInsurance • u/EmotionalEmploy6639 • Jan 08 '25

Claims/Providers How Can I Fight Back Against United Healthcare Denying My Sister's Cancer Treatment?

I'm looking for advice. My 43 year old sister's breast cancer has returned in the form of a bone tumor in her hip, making it stage 4 metastatic. Her oncologist recommended an aggressive radiation treatment. But United Healthcare, in their infinite wisdom (and profit-driven motives), has denied it. As you can imagine, this is infuriating and terrifying for our family.

Does anyone here have experience with battling insurance companies? We are just at the beginning stages of her battle and she has already been denied an initial MRI (paid out of pocket in Germany for one) and now her radiation treatment, as well. Is there any process to avoid continued delays in receiving approvals for her care?

EDIT: Thank you all for the wonderful information. As frustrated and irritated I am about the U.S.'s healthcare system, please keep comments on topic. Comments about vigilantism and recent events may result in the post being locked again and I'd really like to keep it open for continued follow up and commentary from the many informed and helpful peoples who have participated. Thanks for your help!

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237

u/LadyGreyIcedTea Jan 08 '25

I may get downvoted for saying this but insurance companies that deny this kind of treatment are probably hoping/expecting the patient to die before the appeal goes through so then they don't have to pay for it.

104

u/ZellHathNoFury Jan 08 '25

That's literally their plan

12

u/Mechai44 Jan 09 '25

Go to the local news stations and blow it up - assuming family member with cancer is okay with the exposure.

39

u/arianrhodd Jan 09 '25

No downvoting for truth.

64

u/2plus2equalscats Jan 08 '25

This is part of their profit plan. Of all the people you choose to deny, some number of them will give up, go another way, or well… die. By denying more up front, they save more.

16

u/duiwksnsb Jan 09 '25

Murder for profit

11

u/scarfknitter Jan 09 '25

Murder by spreadsheet is murder just like murder in someone's face is murder.

23

u/Kittenlovingsunshine Jan 09 '25

I would love to downvote the concept, but I think you are completely correct here.

20

u/ashalee Jan 09 '25

There’s also a time limit on appeals, so you can be too sick to appeal, and by the time you’re well enough to finally do so, it’s too late.

1

u/Green_Twist1974 Jan 10 '25

That varies by state but minimum is 180 days.

38

u/funkygrrl Jan 08 '25

They are

12

u/Realistic_Jello_2038 Jan 09 '25

Yup. Literally their business model.

7

u/sanityjanity Jan 09 '25

Absolutely. 

Or, if they are the policy holder, they hope you will lose your job (and insurance).

4

u/krispy7 Jan 09 '25

that's entirely reasonable and smart and nothing bad at all should happen to the people who deliberately designed and implemented this system

5

u/SESHHHHHHHHHHHHHHHHH Jan 09 '25

The American dream!

1

u/nava1114 Jan 10 '25

Of course it is.

1

u/Iamthegreenheather Jan 12 '25

It's just like that movie The Rainmaker. That's exactly what happened.

1

u/New_Section_9374 Jan 12 '25

I’m sure there is a relatively explicit memo stating just that floating around in that company’s database. Any whistleblowers listening?!