We have all read and heard horror stories about medical insurance companies and how they just plain refuse to pay for covered medical services and the horrible and life threatening and crippling strain this puts on the average American citizen, his family and his friends. Here is my personal horror story dealing with Universal Health Care Inc of St. Petersburg Florida, their CEO Dr. Akshay Desai from India and his medical director Dr. Edward Lowenstein. ENOUGH IS ENOUGH!
Google: "Domestic Terrorism/Gary's blog" to see my over 2,000 hours of research on this company, the many complaints against it, serious legal problems they had with the State of Florida etc.
My story is repeated tens of thousands of times every year putting Americans into medical bankruptcy and worse, death! This is illegal, immoral, and just plain murder for profit! WHY are our lawmakers not helping US instead of the criminal enterprises calling themselves health insurance companies?
I have complete documentation from my doctors and the hospital showing my needed and emergency care. I have complete documentation from Universal Health Care Inc of St Petersburg, Florida fully authorizing my care with approval letters, letter of guarantee, 5 e-mail guarantees, 2 claim numbers and 8 phone guarantees. THEN after the procedure is finished, UHC denies my care through post claims underwriting! I almost lost my leg and died from this.
While visiting in Thailand in August I experienced escalating severe pain in my knee which was replaced by a prosthesis a year before. An examination and x-rays on October 15 showed a severe infection of the prosthesis that was eating away large amounts of bone material.
The doctor said I needed as soon as possible to have an Urgent operation to have the infected prosthesis removed, that it is an Emergency to do this as I would loose my leg or my life if it was not done as the infection was eating large amounts of bone material and spreading rapidly.
I knew my insurance policy was supposed to cover me for emergencies outside of the country, I purposely bought a policy with international coverage so I immediately called them to determine my coverage. If not covered, I could fly back to the U.S. To get it done.
I told the lady I was calling from Thailand and I had been out of the country for over one year and needed to know what if any coverage I had over here. I emphasized that in Thailand if you do not pay your hospital bill, they will put you directly into a hell hole of a Thai jail until your bill is paid so I needed to know for sure. That is the law here, it is called defrauding a hospital and I was concerned about it. The lady I talked to said I should not worry I was completely covered as long as it was an emergency and I was admitted through the emergency room. She said I would not be covered for any elective procedure. I was e-mailed a document showing $30K coverage every year outside of the country for Emergency and Urgent service.
Three days later when being admitted to the hospital the office and I called again, 2 more times and was again assured I was completely covered, the hospital only needed to fax them copies of their bill and it would be paid is what they first told us.
After my procedure, the hospital several times requested a letter of guarantee from UHC covering my care. UHC totally ignored the hospital. The hospital office then comes after me to call my insurance company and get it straightened out. So as I am laying in bed recovering from major surgery, I am having to call them several times every night at expensive international long distance rates, being put on hold for 10 minutes at a time, also requesting this letter of guarantee and was told not to worry it would be sent. They even gave me a claim number, number U02250952 to guarantee payment and show I was covered!
The hospital did my operation, they had to remove my badly infected knee prosthesis, replace it with a TEMPORARY cement spacer to keep the bones from rubbing, and then I needed powerful IV antibiotics for 6 weeks EVERY DAY to get rid of the remaining bacteria. THEN they would replace my knee prosthesis with a second operation, this was the only way to cure my deadly infection, save my leg and my life and stabilize me.
After this major operation I had to spend over 2 hours EVERY night for 8 nights international long distance being jacked from one person to another trying to get a letter of guarantee.
THEN as I am laying in my hospital bed where I am supposed to be recovering, my insurance company now says they will not pay for the replacement of my knee as they now see that as an elective procedure that could be done in the U.S.! I have NO KNEE, am in a full leg cast and they say it is elective for me to get another one and I must return to the U.S. For it!
This Is Incredible! I am in a full leg cast, IMPOSSIBLE to get on an airplane, must take IV antibiotics EVERY day which in itself is a 3 hour procedure I have no knee, only a piece of cement and they want me to come back to the U.S. And get it done where it will cost 80% MORE than in Thailand and where I have NO ONE to help me after it is over.
My doctor said I could not sit for more than one hour in a car because it would cause cramps and muscle spasms yet UHC wants me to sit for 28 to 36 hours on an airplane I could not get my leg into because of the full fiberglass cast that totally immobilized my leg!
UHC has now put me in a life and death situation, I cannot leave that CEMENT spacer in place of my knee for long or it too will become infected! They OK'd putting it in and will now let me loose my leg or my life by not finishing the procedure they sent my hospital a letter of guarantee starting to save a few lousy dollars!
From My Doctor
Ultimately, after the first half of the procedure was performed, UHC took the position that the re-implantation of the new prosthesis constituted elective surgery and would not authorize it to be done in Thailand.
This position ignored that fact that the full leg fiberglass cast prevented Mr. Ruehle from boarding any commercial airliner, that the altitude would increase swelling, that the antibiotic was a procedure that from start to finish took approximately four hours each day, that Mr. Ruehle was through this time (and still is) in extreme pain and discomfort, that his leg was missing bones and he was to be transported as little as possible, that long distance travel to the U.S. Constituted a major health risk that no responsible medical provider would authorize, and that the re-implantation was simply the second half of the original procedure.
But that great healer Dr. Lowenstein knows better then all these experts and denies any care to me. To him it's not an emergency, but an elective procedure. That he already authorized to be done here. Now he denies me.
It was like talking to a brick, my doctor told him, I told him, the hospital told him, my attorney told him, we sent documents to them that I COULD NOT fly or travel over 1 hour but they insisted I had to come to the U.S. To get done a procedure that they OK'd in the first place to start here in Thailand.
If I did not get the second part of the procedure done, I was again in danger as the cement spacer was only temporary, a foreign object in my body that in itself could cause new infection. I could hardly get around other than sitting or lying, unable to travel and NOW they refuse to finish this operation.
I really got upset by this time threatening to go to the news outlets, writes my congressman, TV 8 on your side, etc. Calli in the complaints department FINALLY told me they would cover the rest of the procedure and for me to NOT CALL them any more that this was between the hospital and the insurance company and all my calls were confusing the issue! FINALLY, peace of mine... Or so I thought.
My doctor decided that I was ok enough to have the procedure finished on the 23rd of February as my system looked cleared up of infection through the blood tests I had every week. So we made the appointment for the 23rd of Feb to finish the replacement started in November.
As life would have it, about the 8th of Feb I came down with severe diarrhea, vomiting, could not eat and was sleeping 16-18 hours per day as I just could not get out of bed for more than an hour each day.
It got worse. Being driven home from a check-up where I was given antibiotics I started to loose my eyesight, everything becoming a blinding white light, cars passing us just looked like spots, I was loosing awareness of what or who I was, or where I was. I felt in my mind like I was dying, I never felt like this in my life. When trying to get out of our truck, I just fell right back into it, I could not walk, even with crutches as I had no balance. I had to use a walker to get to my bed.
My wife immediately took me to the hospital where Dr. Pinij took one look at me and immediately had me admitted. He said that I was dying when I was admitted and I would not have lasted more than another 24 hours.
This was on Monday the 16th of Feb. They found my white blood count was dangerously low, my platelets were low, blood pressure was 90/70, my heart rate up from a normal of 68 shot up to 88 and I had acute infective diarrhea and Bicytopenia and my kidneys were in trouble.
They started IV antibiotics immediately, blood transfusions, platelet transfusions and something for my kidneys as they too were in trouble. The doctor said I truly WAS dyeing and this was an URGENT EMERGENCY now. So they canceled my knee replacement as I had to be bacteria free to do this so the insurance company was never notified to get prior authorization for the knee replacement.
It is different in Thailand than the U.S., if you don't pay your hospital bill here, you go directly to a HORRIBLE Thai Jail, 70 men all hard core Asian criminals jammed into a large cage where you sleep on the floor. It's called defrauding a hospital. You simply stay in jail until your friends and family come up with the money to pay off you bill then they let you out. THIS is where I almost went when UHC did not pay their bill, AFTER authorization my care at least 8 times by phone, a written letter of guarantee, a claim number given, and 5 e-mails from their own medical director, Dr. Edward Lowenstein, saying he would direct his claims manager to pay as soon as they received relative documents from the hospital, which they did, SEVERAL times.
To me these are written contracts between UHC and my Hospital guaranteeing they will pay for my procedure. He said in writing he would pay when he received an invoice and documents from the hospital and doctor. He received these documents several times costing the hospital office staff many wasted hours duplicating things for them for nothing.
THEN Dr. Lowenstein decides to deny payment saying the treatment given to me was elective and I needed to have it done in the U.S.! This was actually his 3rd excuse.
After I complained to CMS he than said that my treatment was not urgent or an emergency and I was only covered for urgent or emergency care! This is his 4th excuse.
My Thai doctors sent him several documents showing they had to do my procedure to SAVE MY LIFE! The good Dr. Lowenstein, medical director of UHC considered saving my leg and my life an ELECTIVE procedure that could be done in the U.S. That saving my leg and my life is not an emergency!
The only thing he uses his medical license for is to further injure or kill sick people for a profit for his company. His medical license is useless for helping or saving sick people as the oath he once took supposes of him. It is used for one thing, to help the bottom line of UHC.
This was his first denial of payment. He then proceeded to find 4 other excuses to deny me then he retroactively my many months prior to my procedure, dis-enrolled me saying I was never covered in the first place and any approval letters and letters of guarantee, claim numbers, fax approvals and e-mail approvals sent by the good folks at UHC are now void and useless!
This is total outright FRAUD and mis-representation. It is known as "Postclaims Underwriting" also called "Retroactive Underwriting" and Florida law flatly prohibits this practice but insurance companies do is routinely. Why are none of these insurance officials being arrested for breaking the law?
At least seven written documents, contracts by Desais company they just arbitrarily toss out and refuse to honor leaving the patient to fight with them when the patient is at his weakest and most vulnerable. Attacked by their own insurance company when they are down.
They took my money then denied payment when I needed it. They gave seven written contracts that they would pay. They broke these contracts leaving my family and myself destitute. My feeling is this is outright fraud. This is my complaint.
And Dr Akshay Desai, their CEO agrees with this horrible decision as he has done nothing about it. Just take the money and have lavish parties and visit with big shots for photo ops and political donations.
When they denied me service, the hospital stopped all treatment to me including the daily IV antibiotics and physical exercise I needed for another 6 weeks to kill the remaining bacteria in my system and started charging me EVERY DAY for my room and the medications I desperately needed to save my leg and my life.
I had an armed guard put at my door to make sure I did not escape from the hospital without paying my bill. They were after me every day to pay on my bill or go to jail. My wife could not come to visit me without the collection department demanding money from her or her husband would go to jail. Everyone who saw me knows me as the foreigner that tried to cheat the hospital!
Suddenly I am living in true TERROR. The horror of my immediate life became immediately apparent when they had the Thai Police come to my room and take a report of this foreigner that was trying to defraud them and they wanted to press charges against me.
I just went through a major surgery yet had their collection department after me EVERY DAY trying to collect money or I would go to a Thai jail where I would get NO medical care and would probably die.
EVERY DAY my wife had to come up with money to pay on my bill or they would call the police for me. This made NO difference to Universal Health Cares medical director Dr. Lowenstein who proceeded to dis-enroll me saying I was now out of the country to long! This is called Post Claims Underwriting and is illegal, immoral, and outright murder for profit.
He knew I was out of the country when he gave my hospital a letter of guarantee to start this 2 part procedure. He sent it.
If I was out of the country to long, they should have told me that on my FIRST phone call and I could have flown back to the U.S. For treatment. They did not. They said I was OK. Many times.
Page 14 of my policy says I am covered for $30,000 emergency and urgent care outside of the country EVERY YEAR.
What a terrifying and horrifying experience I was going through. It was like a living nightmare brought on by the practices of Desai and his insurance company and how he runs it.
Even CMS does nothing about it, just takes the reports.
Dr. Lowerstein had previously FINALLY given the hospital a letter of guarantee that they would pay for my services, sent 5 e-mails to this effect, we had at least 8 phone approvals they would cover me, then this man changes his mind AFTER the procedure he authorized in the first place. He says after reviewing the several documents from Dr. Pinij, my personal doctor at AEK Udon International Hospital and my other doctors showing the urgent and emergency procedure they gave me to save my leg and life and the hospital offices themselves, he says he does not see this as an this as an emergency therefore it is not covered!
He used no less than FIVE DIFFERENT REASONS to deny my claim. Even though my doctors, the hospital and later my attorney all appealed to this he denied my claim putting me in a horrible terrifying life threatening situation.
I was terrorized EVERY day by the collection department and their threats of jail when I should be relaxing and healing from a major procedure. I did not know from one minute to the next if I would have the life saving IV's removed from my arm and taken by the Thai police directly to jail with my leg in bandages that had to be changed every day.
THIS is the horrible situation MY insurance company, Universal Health Care Inc, its CEO Dr. Akshay Desai and his medical director Dr. Edward Lowenstein has put me in. Living in fear EVERY moment of EVERY day. Not knowing if my wife found anything else from our house to sell so she could bring them some money.
Universal Health Care took my money for my premiums every month knowing I was living out of the country for an extended period of time every year, what country and where I was at, I always phoned them to keep them up to date with where I was traveling at even! Living in a foreign land, available emergency medical care was most important to me and not neglected. And in my hour of need, they treat me like I am some sort of criminal and will allow me to DIE in a most HORRIBLE way and say..."sorry, there is nothing we can do?" They sold me a policy they knew at the time was totally illusionary to my requirements.
My blood pressure rose dramatically and needed to be medicated. I was going crazy by this time, mentally exhausted, getting physically sick again my leg swollen down to my foot, in a foreign country and not knowing what to do. Now I am being CHARGED for every day I am in the prison hospital, charged for my room, my medicine and IV medication I desperately needed after a major surgery, any food I ate. Almost $100 per day was adding up against my bill that had to be paid in FULL before they would release me.
My attorney sent letters to Dr. Lowenstein and Universal Health Care indicating that I could loose my leg or my life, the man was completely unmoved by all this, totally willing to let me DIE and actually now started using the full backing of Universal Health Cares powerful Legal Staff against me.
They do not even try to help me, their customer, No in my time of serious need from those I put my complete medical insurance trust in, treat me like some mangy cur to be tossed out the back door and sick their legal dogs on me to scare me away no matter WHAT the consequences to me or my family or those around me who will be so tragically affected by these their decision so save their companies bottom line a few more precious DOLLARS and human life and limb be damned.
WHY must we the consumer suffer like this at the hands of people like Dr. Edward Lowenstein whose sole job with Universal Health Care is to TURN DOWN as many claims as possible?
And what to think of those insurance companies that pays bonuses to their employees for policies that they cancel to save the company money?
I ended up having both a mental and physical breakdown with terrible swelling of my knee and leg and went into convulsions where they had to rush me to the Emergency Room for treatment and to get my shaking and convulsing under control and to reduce the swelling so I did not loose my leg.
My doctor that did my operation and saw me in the ER as I was having my breakdown from mental stress and strain felt so sorry for what I and my family were going through because of Universal Health Care that HE gave the hospital over $2,000 of HIS OWN money to put against my bill and signed a hospital paper that if I did not pay the balance he would be responsible for it!
My wife and family too were terrified, not knowing what was going to happen to me. I was not allowed to come home at night, I was a prisoner in the hospital with an armed guard every place I went, expecting to go to a real jail any moment.
My wife was forced to pawn all her jewelry and wedding gifts and sell everything of value in our house for whatever she could get for it to pay on my bill to keep me out of jail losing considerable face with her friends and neighbors, something very important to Asian people. She had to give her beautiful truck, a 2006 Isuzu to the hospital to keep me from being sent to jail. This in turn cost us the loss of our business as we had no transportation now or any money to work with.
We were all terrorized not knowing from one minute to the next what was going to happen to us all thanks to the policies of Dr. Akshai Desai of St. Petersburg, Florida and Universal Health Care Inc.
Finally after my extremely upset wife sold everything of value that we had in our house, even having to show the hospital our bank accounts then turning them over to the hospital and us borrowing from every person we could think of, the hospital finally released me.
I now had less that $100 to take care of my entire family and pay our bills and eat. And no transportation or way to work.
Universal Health Care and Dr. Akshay Desai left us medically bankrupt AND destitute with almost no food to eat. He totally sucked us dry in order to squeeze every dollar he can for his company and his excesses.
I still needed the 6 weeks of IV antibiotic treatment EVERY day and had to beg and borrow again for this treatment which was never completed as each treatment was over $60 per day or over $2,500 for the 6 weeks. This made no difference to Dr. Loserstein whose only job I can see is to use his medical license as a sham to deny services and overrule the decisions of credible medical doctors.
This is only a short version of the horrors I faced thanks to Universal Health Care of St. Petersburg, their staff and Dr. Akshay Desai in particular. And I say Dr. Desai in particular as he is the CEO of this corrupt company and obviously approves of the service his company fails to provide the people who depended on his company. Thinking they were covered only to find in their time of need UHC will certainly disenroll them using post claims underwriting and to see their formidable legal department turned loose on them when they are at their weakest leaving them to loose limbs or their very life. This is Criminal. These people are no different than murderers. They deny care letting people die.
And remember, I am only one of hundreds of thousands of similar horror stories that feed the greed of these terrible health insurance companies. No one is reading about them. But we are literally dying because of insurance companies drive for profit.
The insurance companies and health care industry, "Big Pharma" are bleeding us dry to where we have nothing left for ourselves and our families except medical bankruptcy and loss of our entire lives work and possessions.
Who is helping us, the American Taxpayer? Why are our legislators bending over backwards to provide for the criminal INSURANCE COMPANIES? Their payoffs through their lobbyist at the cost of the health and welfare of American People must stop. We are dying out here, is no one listening? Because of the number of people who died due to rescission of their otherwise valid health care policies, 25,000 children and 50,000 adults, we should put those who run the insurance companies, or reward their employees for terrorizing people by refusing care in jail. Forever. This is DOMESTIC TERRORISM on an incredible scale and is going unchecked.
This is an outrage that can only be eliminated by making the insurance companies pay a price for the damage that they do. America, wake up! Each one of you who thinks that you are covered has no way of knowing - until it is too late - that this is the normal practice of the people who gladly take your money until you are sick or injured, and then they let you go down the toilet by dis-enrolling you on a pretense. It should be considered DOMESTIC TERRORISM.
Gary M Ruehle St. Petersburg
0 comments