Are you a Medicare Advantage patient insured by United Healthcare? Have you been wrongfully denied for medical necessary treatment or durable medical equipment (DME?)
If you or any of your loved ones are Medicare Advantage patients who have received denials from United Healthcare and have experienced adverse health outcomes, a reduction in life quality, or death as a result, you may be eligible to join this class action lawsuit. Read on to learn about Michael's story and get in touch with him here.
MICHAEL'S STORY
HOW A $3000 DENIAL LED TO LOSS OF HIS LEG
Michael Kissling is an amputee. But he wasn’t always one. His struggle with UnitedHealthcare began in 2018.
Michael was born with May Thurner's Anatomy. This means the main artery and vein in his leg, which should have run parallel, crossed over. The crossing of the artery and vein caused a pinch point that, during moments of high blood pressure, was susceptible to clotting. His first clot was at age 15, then 17, then he was stable until age 27. After that, the problems worsened.
Three separate doctors gave Michael the recommendation to receive a stent in his left leg. The stent would hold open the pinch point to prevent new clots.
UnitedHealthcare refused to cover the procedure, claiming he did not qualify for the stent.
May Thurner's Anatomy meant Michael's left leg was prone to damaging blood clots
CLOTTING, SWELLING, AND SURGERY
By 2018, Michael’s leg had become swollen and painful as a result of the clotting. Without proper drainage of the vein, his limb became like an overfilled water balloon. It was agonizing to even walk on it. Eventually, the prolonged clotting meant his body couldn’t get oxygen or nutrients to the cells in his leg—causing those cells to die, creating dead tissue and non-healing ulcers. After 17 months of treatment, he finally healed when he was treated with Apligraf (a type of bioengineered skin graft). But when the clotting reoccurred, UnitedHealthcare denied use of Apligraf for eight months. By then, the damage was too severe for the treatment to be effective. Michael’s wounded leg refused to heal. With the possibility of a life-threatening infection and the fear he would lose either his leg or his life, Michael chose his leg.
The amputation occurred on February 1st, 2023.
But this was not the end of Michael's struggle with UnitedHealthcare.
Michael's left leg became swollen and painful as a result of clotting, and he developed severe, non-healing ulcers
Pictured here practicing on the pre-learner leg. Amputees progress to a learner leg and eventually to the tertiary prosthetic (the one for mobility and daily life).
TRAINING FOR THE PROSTHETIC
Now an amputee, Michael needed to relearn how to walk, this time with a prosthetic. His training began with a learner leg, a simplified, temporary device used as preparation for the tertiary prosthetic. Note that the learner leg is not intended for long-term use by amputees. It is the tertiary prosthetic that is the actual prosthetic leg needed for everyday mobility.
In September of 2023, Michael was ready to receive his first tertiary prosthetic.
UnitedHealthcare denied coverage for it.
Despite both his physical therapist and doctors advocating on his behalf, UnitedHealthcare continued to issues denials for Michael’s prosthetic leg.
Finally an external review organization, MAXIMUS, overturned UnitedHealthcare’s decision, but by then the damage was done. By that time, Michael had developed a bone spur due to the pistoning effect on his leg, requiring an amputation revision surgery—a painful and avoidable outcome.
CLASS ACTION LAWSUIT
Michael’s ordeal of repeated denials is a painful, vivid illustration of how the health insurance industry’s profit model leads to suffering, pain, and negative health outcomes for patients. His situation highlights the need for accountability and change within the health insurance system.
According to his vascular surgeon, the $3000 stent not only could have saved his leg, it would have prevented all the medical costs that followed—well over a million dollars.
On the day of Michael’s discharge from the hospital, August 23rd, 2024, UnitedHealthcare canceled his policy, claiming he no longer qualified for coverage.
The consequences of United Healthcare’s actions have been profound, resulting in significant physical, emotional, and financial distress to Michael and his family. Their refusal to provide coverage for a necessary prosthetic flies in the face of ethical medical practice and humane treatment.
Michael is now seeking to file a class action lawsuit against UnitedHealthcare for the harm they have caused. He is currently in legal consultations and has been informed that he has a strong case if he can find other patients with similar complaints to make it a class action suit. He hopes that by sharing his story, he will embolden more patients to fight back, and find others to join him in his legal battle.
Denials and delays in receiving the prosthetic caused profound damage to Michael's leg, requiring a corrective surgery.
Despite challenges, Michael remains determined to fight for himself and others.