From: Herbert Stein [mailto:firstname.lastname@example.org]
Sent: Wednesday, February 05, 2014 12:49 AM
To: Stephen J. Hemsley – CEO, United Healthcare
Cc: Jonathan Blum, Deputy Administrator and Director for the Center of Medicare at the Centers for Medicare and Medicaid Services; Amy Larrick, Senior Advisor to the Principal Deputy Administrator Centers for Medicare & Medicaid; Madam Secretary Kathleen Sebelius, United States Secretary of Health and Human Services
Subject: United Healthcare medical Policy Number: 2014T0101Q
To Joyce’s fellow VNS patients et al.,
The below listed link and attachment is United Healthcare’s recent policy as it relates to VNS Therapy.
United Healthcare has denied replacement surgery to an existing VNS Therapy depression patient and then subsequently also denied the patients first appeal. The patient is now working on a second appeal.
Yet United Healthcare’s Medicare Advantage PPO program paid for two (2) patient replacements, one of those being my spouse Joyce. At the time United Healthcare’s representative floundered over me to insure that Joyce’s surgery and needs were all taken care of for which I was most appreciative (and thank you too Amy Larrick, CMS). Now we have United Healthcare’s reversal of care toward a private subscriber payer.
The decision on the part of United Healthcare and it’s CEO is truly an abomination as well as cruel and goes against CMS informal decision of September 26, 2013. The lack of humanism and compassion for this patient is unfathomable. The denial overlooks and does not take into account the most important fact of all; the patient maintained wellness for multiple years and now that the battery has depleted the patient is slipping back into the abyss of a major depressive episode. This fact, in the case of this patient as well as other existing VNS Therapy depression patients wishing to continue with their therapy contradicts a number of the assessments contained in the United Healthcare medical Policy Number: 2014T0101Q.
“UnitedHealthcare reserves the right, in its sole discretion, to modify its Policies and Guidelines as necessary. This Medical Policy is provided for informational purposes. It does not constitute medical advice.”
Just quickly, what I find of interest right-off-the-bat in this policy is the fact it does not indicate who prepared this policy. Was it some bureaucrat or youngster sitting in front of a computer making this determination? Was it a medical professional(s)? More importantly, was it a medical professional(s) with psychiatric credentials and/or certification? Was it one of the notorious ghost writers often found preparing research study results or documents of this nature? Then there is the fact that “UnitedHealthcare reserves the right, in its sole discretion, to modify its Policies and Guidelines as necessary. This Medical Policy is provided for informational purposes. It does not constitute medical advice.” And yet United Healthcare totally disregards the patient’s highly qualified psychiatric medical professional’s statements as to why the patient requires this therapy.
There will be more to follow as I gather my thoughts and share my facts and opinions based upon what I consider a subjective and flawed policy lacking true understanding of the nature of Major Depressive Disorder (MDD) as explained in United Healthcare medical Policy Number: 2014T0101Q. The fact the policy discriminates against patients who have obtained multiple-years of wellness and require access to replacement and care to maintain their mental health, general wellbeing and reasonable quality of life goes beyond reason and logic.
Joyce and Herbert Stein
1008 Trailmore Lane
Weston, FL 33326-2816
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