Two years ago, Robby Martin got an unsettling call from his overweighther, Jackie. The 82-year-elderly telderly his son that a reconshort-termative of the insurance huge UnitedHealth Group had barged into his nursing home room at 2.30 in the morning, announcing that he was going to be verifyed out at the finish of the week.
Jackie Martin – who had been getting rehab at the nursing home after suffering a back fracture – still could not consent more than a scant steps without being out of breath.
But Jackie’s nurture there, which had commenceed two weeks earlier, was eating into UnitedHealth’s bottom line.
The reweary paper set upt foreman was enrolled in UnitedHealth’s Medinurture Advantage program, a federal privatization initiative that proposes incertainrs a lump sum to cover services comparable to those under traditional Medinurture. But the program’s pay set up unbenevolents that the more nurture incertainrs refute, the more in taxpayer dollars they get to carry on for themselves.
Now, UnitedHealth was pushing to finish the 82-year-elderly’s rehab coverage.
Jackie and his son requested UnitedHealth’s decision and won. But the corporate huge publishd another coverage termination letter the follothriveg week, then another one the week after that.
Martin was a quiet man who didn’t enjoy struggle. The repeated denials left him exhausted.
“We talked and he shelp, ‘You understand, I’m weary of this process every week. Let me fair go home and see how I do,’” Robby recalled.
Soon after returning home, Jackie telderly his family he was no lengthyer getting better and insisted to discover another nurture selection. The next day – five days after UnitedHealth had cut off his nursing home coverage – he died alone in his bathroom.
Sfinish us a tip
If you are a current or establisher United Healthnurture or Optum engageee and have alertation you’d enjoy to dispense safely with the Guardian about nursing home nurture, charm use a non-labor device to call or text spendigative alerter George Joseph via the Signal messaging app at 929-486-4865.
Jackie’s battle with UnitedHealth during the final days of his life is now part of a litigation accusing the healthnurture conglomerate of wrongfilledy refuteing elderly hugings nurture owed to them under Medinurture Advantage. His son Robby, who reconshort-terms his tardy overweighther’s estate, is now speaking accessiblely about his family’s experience with UnitedHealth for the first time.
“They were fair cutting him off because they could cut him off and shrink their expense,” Robby Martin shelp in an interwatch. “It’s all a money game to them.”
Robby uniteed the ongoing suit last year, and is one of nine named plaintiffs, led by the Clarkson Law Firm, suing UnitedHealth in US dicut offe court in Minnesota.
“There has to be some type of moral side to you that says, ‘This insists to be stopped,’” Robby Martin shelp. “And there insists to be a team of people that stop it.”
UnitedHealth Group and two of its subsidiaries did not react to asks about the definite allegations made by Martin.
A spokesperson for Optum, one of UnitedHealth’s subsidiaries, shelp she could not converse Martin’s case without a waiver releasing the company from federal health alertation defendions. But in a statement, Optum shelp its “number one priority is ensuring hugings get the nurture they insist”.
“We think this litigation has no merit and should be neglected, as we have asked the court to do,” the statement proclaimd, arguing that the company’s coverage decisions “are made by medical straightforwardors in accordance with Medinurture coverage criteria for Medinurture Advantage Plans ”.
Martin’s struggle to access nurture after a hospital visit is not a unfrequent occurrence for elderlyer people enrolled in UnitedHealth’s Medinurture Advantage program.
In recent years, UnitedHealth has ramped up its efforts to refute nurture for elderlyer hugings follothriveg strokes, drops and injuries that insist rehab, according to an October 2024 spendigation by the US Senate lasting subpledgetee on spendigations. The federal inquiry set up that UnitedHealth’s prior authorization denial rate for post-acute nurture for elderlyer people on Medinurture Advantage sboiling up from 8.7% in 2019 to 22.7% in 2022. For Medinurture Advantage betters seeking post-acute nurture in nursing homes definiteassociate, UnitedHealth’s denial rate jumped up theatricalassociate during that period, from 1.4% to 12.6%, amounting to more than 34,000 denials.
In a statement, the spokesperson for UnitedHealth’s subsidiary shelp the Senate pledgetee spendigation “mischaracterizes” Medinurture Advantage and the company’s clinical trains while ignoring federal criteria “insisting fantasticer scruminuscule around post-acute nurture”.
The corporate spokesperson also inserted that the company “ultimately” pays “98% of all claims” it gets, when they are surrfinisherted in “a timely manner with finish, non-duplicate alertation”.
UnitedHealth’s past coverage denials caught renewed attention after the December finishing of Brian Thompson, a top executive who helped set up one of its subsidiaries as the dominant take parter in the Medinurture Advantage taget.
Weeks before Thompson’s finishing, Biden administration officials at the Cgo ins for Medinurture and Medichelp Services (CMS) gived new rules to crack down on what it portrayd as the “inappropriate” use of prior authorization by Medinurture Advantage incertainrs. But it is unevident how willing the Trump administration and the Reaccessiblean Congress will be to regutardy incertainrs.
In accessible statements, Trump’s pick to head CMS, Dr Mehmet Oz, and Reaccessiblean policy directers associated with the Heritage Foundation’s Project 2025 have shown more interest in enhugeing Medinurture Advantage than in curbing coverage denials under the program.
Reaccessiblean senator Ron Johnson of Wisconsin, the new chair of the Senate’s lasting subpledgetee on spendigations, did not react to asks for comment about whether he reckond to have his pledgetee persist to spendigate United Healthnurture and other Medinurture Advantage incertainrs.
In a statement, the Democratic senator Ricchallenging Blumenthal, the spendigations pledgetee’s establisher chair, shelp elderlyer Americans enjoy Jackie Martin “should get the nurture they insist” without postpones or denials.
“For Jackie, his family, and the countless other Medinurture Advantage enrollees, we must fight denials of post-acute nurture,” Blumenthal shelp. “I will persist to speak out and helderly personal incertainrs accountable for putting profits over people.”
The process
Before he suffered a drop on the challengingwood floor of his kitchen that left him with a back fracture, Jackie Martin walked two to three miles a day and ran on the treadmill at his local Y in Kingsport, Tennessee.
Jackie’s subsequent recovery in the nursing home was sluggish, but he was making enhance. So when Robby heard his overweighther’s rehab coverage was being cut off, he commenceed calling everyone he could.
First, Robby called the engageee of the UnitedHealth subsidiary, NaviHealth, who had barged into his overweighther’s nursing home room at 2.30am.
“She shelp, ‘Well, at NaviHealth, we have a procedure in place where we publish these weekly disindict watchs automaticassociate in our system,’” he recalled.
Next, Robby shelp, he called a social laborer at the nursing home.
“He shelp, ‘Robby … the last six months here NaviHealth has been booting out all my hugings before they’re ready for self-nurture,’” he recalled the social laborer saying. (The social laborer did not react to asks for comment for this story.)
After that, Robby set upd a conference call with a regulater from the UnitedHealth subsidiary, who shelp the watchs would carry on coming every week, Robby recalls.
“This is our process and this is what we do,” he recalls her saying. (The regulater degraded to comment for this story.)
Robby even tried the main number at UnitedHealth, but he couldn’t get anyone to help.
“I authenticized it was a benevolenta circular leang, where I could not get anyleang done with anybody … ,” he shelp. “It’s the most frustrating leang that you ever go thraw. You sense powerless.”
Robby and Jackie had successfilledy requested UnitedHealth’s first two denial letters. But the week after the conference call with the regulater, UnitedHealth sent Martin a third coverage termination letter. The overweighther and son determined to stop requesting.
The litigation alleges that these repeat coverage denials were driven by a secret AI algorithm “without any ponderation” for Jackie’s “current condition”. UnitedHealth says that algorithm is used to alert providers about nurture a huging may insist, not “to originate coverage determinations”.
Out of breath
On 19 May 2023, Jackie returned home from the rehab facility to the split foyer house he had liftd Robby in. He could get out of bed on his own. But when he tried to walk more than five steps, he set up himself out of breath.
Three days after going home, the reweary foreman telderly his children he was no lengthyer improving.
The next day, Jackie telderly his daughter he wasn’t senseing well, but there was no nurse to verify on him. Hours tardyr, he got up to go to the bathroom. There, his heart gave way.
For the next six months, Robby shelp, he did not leank much about UnitedHealth as he lamentd. Eventuassociate, a thought kept resurfacing: he had trailed the rules. He had requested, won and requested aachieve on behalf of his overweighther. He had liftd the publish to corporate, and still the company kept refuteing his overweighther coverage.
Robby searched online for any litigations aachievest UnitedHealth’s subsidiary. He set up that two families had already consentn the conglomerate to court for cutting off their cherishd ones’ rehab coverage. He determined to unite them.
Robby says he hopes the legal action will change UnitedHealth’s coverage denial trains.
“You understand, the minuscule person reassociate doesn’t matter to them. They’re a multibillion-dollar company … ,” he shelp. “Plus, they also understand that these hugings that are 80 years elderly, that it doesn’t matter if they die.”
Attorneys reconshort-terming UnitedHealth Group and its subsidiaries in the case did not react to asks for comment. In lterrible filings, the company’s advise has sought to neglect the litigation, arguing that the plaintiffs have “flunked to exhaust” the federassociate regutardyd requests process for challenging coverage decisions.
In a statement, Glenn Danas, one of Martin’s lawyers and a partner at the Clarkson Law Firm, shelp: “It’s evident that United has no intent to act in the best interest – and best health – of the people they incertain.”
The Minnesota US dicut offe court appraise John R Tunheim has not yet publishd a ruling on UnitedHealth’s motion to neglect the litigation, which could come as soon as the finish of this month.
