A Huge Bump in the Road

We all agreed. My doctors, advisors, friends and family strongly believe acute rehabilitation is the only way to restore my lost muscular strength. I was all set to pack my bags and head to Encompass Rehabilitation Hospital of Danbury, just down the street. Here in the development where I live. Then I got a call from UnitedHealthcare. UHC said my request for authorization was denied. They further said if I selected a skilled nursing facility, within 24 hours they would agree to pay for it. We have some fine nursing facilities in the area, but I know what I need, 3-4 hours per day of acute rehabilitation.

I have lost 10 pounds since the beginning of the cruise and 30 pounds over the year. I need daily consultations with a dietitian in addition to the tough workouts I will be getting from physical therapy.

I told UHC I wanted to appeal. They said the answer was no, no, and no. I decided to proceed with Encompass on a private pay basis. I am confident in the long run it will be a worthwhile investment in my body.

I can see why UHC doesn’t like acute rehab. It is expensive. Over the past five years I have had a heart implant for stroke protection, a pacemaker, two major surgeries at Yale, and 66 days in the hospital accompanied with tests and medications. Combine that with acute rehab and the JRP/UHC account looks like a real loser. IBM pays my UHC premium and then the government deducts $649 per month for medical benefits. The combined payments for medical don’t come close to my medical expenditures. 

However, don’t feel bad for UHC. UnitedHealthcare covered approximately 50 million members in 2024. The company collected $308.8 billion in premiums and paid $264.2 billion in claims. This was not a good year for them. UHC has faced intense public scrutiny over claim denials and prior authorization practices. I have just witnessed this personally. 

I am looking forward to the coming week and will let you know how it goes.