‘It Makes Me So Angry’: South Carolina Mom Feels “Helpless” After UnitedHealthcare Denies Her Son’s Rehabilitation Care After a Motorcycle Accident
This is where the system starts feeling impossible
Getting into a rehabilitation program after a serious brain injury should feel like a hopeful step. But for one South Carolina mother, getting her son accepted was only part of the fight. His insurance company still had the final say.
Families have already raised questions about UnitedHealthcare denying care for their children, even when treatment is recommended. For Trina Alvarez, that fight came while her 25-year-old son, Peyton Alvarez, was beginning to show signs of recovery after a serious motorcycle crash.
According to the Daily Mail, doctors once warned Trina that Peyton might never wake up. But he did, and small signs of progress gave his family hope. Now, his mother claims an insurance decision is standing between him and the next stage of his recovery.
Then Came the Roadblock
Peyton, an airline mechanic at PSA Airlines, crashed his motorcycle into a tree in Greenville, South Carolina, on April 28. He was wearing a helmet and other protective gear but suffered a serious brain injury and remained unconscious for about a month and a half. In early June, he opened his right eye.
Trina said Peyton can now move his left arm and wiggle his toes when asked. His doctor recommended transferring him to the Shepherd Center in Atlanta, which specializes in brain and spinal cord injury rehabilitation. The facility accepted Peyton, but his mother claims UnitedHealthcare wouldn’t cover his treatment there.
On July 7, Trina received a denial letter calling Peyton’s treatment “medically unnecessary.” She appealed with his doctor’s recommendation, but claims that was denied too, leaving her challenging an insurer’s decision while her son’s care was on the line.
“It is so frustrating. It makes me so angry that they can control what happens with my son because the longer he stays at the hospital he’s at, the less chance he has to wake up,” Trina said.
She also described feeling “helpless” while trying to get her son the care she believes he needs. “When you push a parent to the point of feeling like they are helpless, and may contribute to whether their son may ever be able to talk or move his arms and legs or sit up on his own, that should not be allowed,” she added.
The dispute partly comes down to Peyton’s score on the Rancho Los Amigos Scale, which tracks cognitive recovery after a brain injury. Trina said he is at Level 3, while UnitedHealthcare wants him at Level 4 before covering treatment at the Shepherd Center.
But Trina believes the requirement creates a problem because the rehabilitation could help him reach that level. “But the problem is, getting him to a four is dependent on him getting in the [Shepherd Center] program,” she explained.
Peyton has continued making progress. His mother shared that he can now stay awake for hours at a time and hold his head up on his own. She believes getting more stimulation could help his recovery and worries that waiting could cost him valuable time.
“Based on the clinical information we have, Mr. Alvarez has alternative full-time care options covered under his plan that can provide rehabilitative therapy. We are ready to work with the family as soon as they make a decision,” UnitedHealthcare said.
Trina claims the alternative is a skilled nursing facility, which she doesn’t believe would provide the care Peyton needs. “When would anybody be okay with compromising on their son’s medical treatment?” she asked.
Trina is considering transferring Peyton to Hermann Hospital in Houston and paying out of pocket. If he reaches Level 4 on the Rancho scale, he may qualify for coverage. She is also considering changing insurance providers to get him the rehabilitation she believes he needs.
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