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Before he moved to town in 2016, Dr. Kevin Casey served as a Navy trauma surgeon during the U.S.-led wars in Iraq and Afghanistan. Now, when he\u2019s not performing 10-hour surgeries or making his rounds, Casey and his team of billers at Santa Barbara Vascular Specialists do battle with American insurance carriers over their routine denial of care.<\/p>\n
Casey is constantly frustrated by the machinations of the private health insurance market, describing it as a fundamentally broken system that prioritizes profits above all else. But the tactics of one particular company \u2015 UnitedHealthcare, the largest health insurer in the United States that reported $448 billion in revenue last year \u2015 have appalled and \u201cenraged\u201d him, he said.<\/p>\n
\u201cWhile their immoral actions are too numerous to state, my most recent interaction with them was inexcusable and exemplifies yet another breach of their contract with patients,\u201d Casey wrote in a letter to the Independent, which was followed this week by an interview.<\/p>\n
Casey stated that, in his medical opinion, a long-delayed decision by UnitedHealthcare to approve coverage for an 82-year-old patient \u201cultimately contributed to her preventable death.\u201d Casey said he was sharing his patient\u2019s story with the permission of her family, who wished to keep their identities private.<\/p>\n
Representatives for UnitedHealthcare \u2015 whose CEO last month received withering criticism from a bipartisan panel of Congress over rising consumer costs \u2015 did not respond to multiple requests for comment.<\/p>\n
Jane Doe was an active and vibrant member of the Santa Barbara community, Casey said, who, in her later years, suffered from severe peripheral arterial disease. Despite multiple attempts to save her foot, Doe underwent a below-knee amputation in December.<\/p>\n
Following the surgery at Cottage Hospital, Doe was discharged to a skilled nursing facility to recover. Five days later, she was readmitted to Cottage for \u201cfailure to thrive.\u201d But Doe bounced back, and soon met all the criteria to return to the nursing facility, where she would receive physical therapy and other critical support not available from a hospital bed.<\/p>\n
\u201cThis is where UnitedHealthcare intervened,\u201d Casey said. The company refused the placement. \u201cDespite continual requests to understand why, no justification was given,\u201d he said. \u201cThis is a woman who was a new amputee, had no immediate family to help, and required more intense nursing care than could ever be provided at home.\u201d<\/p>\n
Casey\u2019s team spent the following days challenging the denial. They were told they could make a \u201cphysician appeal\u201d and would receive a response within 72 hours. Five more days passed with no word from UnitedHealthcare. \u201cOur physicians and social workers called continuously, requesting an answer and were either put on hold indefinitely or blatantly disregarded,\u201d Casey said. \u201cOne physician on my team was hung up on after 45 minutes of waiting. \u2026 These are busy surgeons trying to do what is best for a patient and do not have time to be on hold that long.\u201d<\/p>\n
Meanwhile, Doe was declining. She was growing depressed sitting in the hospital with no sustainable plan in sight. \u201cShe felt abandoned,\u201d Casey said, all because she was waiting on UnitedHealthcare to approve a medically necessary discharge to the nursing facility. By all measures, a transfer of this nature would be considered standard of care, said Casey, who currently serves on the board of the Central Coast Medical Association. \u201cConversely, refusal to do such is blatantly outside of such standards.\u201d<\/p>\n
After 26 days, the family\u2019s personal appeal was approved. UnitedHealthcare offered no explanation for their reversal. However, the company then said it had made a paperwork error and Doe would need to wait in the hospital another three days. Finally, Doe was transferred to the nursing facility, but she was considerably weakened and despondent. Shortly thereafter, she died.<\/p>\n
\u201cTheir strategy is very clear and methodical,\u201d Casey said. \u201cBy creating countless hurdles for either procedure approval and\/or denial of payment for standard medical care, they ultimately discourage a percentage of physicians and patients from seeking care.\u201d The constant stress of these roadblocks contributes to the burnout plaguing medical providers across the country, he said.<\/p>\n
Casey pointed to two other cases of delay involving different insurance agencies that resulted in devastating outcomes for his patients. One needed surgery on his wounded leg. The night before the procedure, coverage was denied. The patient then became septic and passed away. Another patient required treatment for a chronic vascular condition that was similarly denied but later approved. They are still struggling with long-term complications from the delay.<\/p>\n
\u201cYears of frustration and anger are finally bubbling over,\u201d said Casey of his decision to speak out now. \u201cWe are part of a system that is not working, and we pay into this system. So, you expect to have services that are humane and meet your needs.\u201d Doctors throughout the United States work tirelessly for their patients. \u201cOn the other side, you\u2019ve got people who can make decisions without any regard for outcomes,\u201d he said. Oftentimes, those people are not physicians. And sometimes, they\u2019re not even human, with life-or-death calls made increasingly by artificial intelligence.\u00a0<\/p>\n
Casey took his complaints about UnitedHealthcare and Jane Doe to the California Medical Association and has reached out to elected officials. He said he plans to keep ringing the alarm bell with more stories of \u201cunethical decisions\u201d executed by UnitedHealthcare and other insurance companies.<\/p>\n
\u201cI hope other physicians and healthcare providers feel compelled to write in about their experiences as well,\u201d he said. \u201cOur patients have a right to know that this is happening to their friends, their family members, and possibly themselves in the future.\u201d\u00a0<\/p>\n
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