UnitedHealth said it was too dangerous for him to be discharged. Days later, it denied his care
Health insurers continue to use algorithms to predict how long patients need intense care — and thus how much care is covered, an attorney says. #STATBreakthrough
SAN FRANCISCO — When Megan Bent and her mother won the last appeal against UnitedHealth’s denial of care for her father, she remembered the reason given: it was unsafe for him to come home. Bent’s father had been recovering at a rehabilitation facility after brain surgery to remove a melanoma metastasis. Three days later, his condition hadn’t changed, but Bent and her family received another denial of care. It was their third denial and, this time, they lost.
These denials came after NaviHealth, a company that uses an algorithm to estimate a patient’s care needs and was doing so for UnitedHealth, told the family he only needed a couple weeks to recover. That flew in the face of what the neurosurgeon and physical therapist told the family. The medical team expected Bent’s father would need at least three months in the facility, Bent recalled.
