Fuck UnitedHealthcare
A summarization of the pain I went through just to get a single medication covered by an American insurance company.
My son has growth hormone deficiency, making him short for his age. To combat this, he takes supplemental growth hormone, either a daily or weekly subcutaneous injection depending on the brand of medication he’s currently-prescribed. This has been his routine for the past five years — and will be for as long as possible, until his growth plates close as all children’s do at some point during their teenage years.
So time is of the essence, and keeping his regimen running smoothly is important. That’s why I’m here to tell you how fucking pissed off I am at UnitedHealthcare (UHC).
Because UHC feels they know better about my son's health compared to the professionals that have been taking care of him for a third of his lifetime, they’ve put a two-month delay on his regimen (that is still ongoing as I publish this).
In January, our insurance changed to UHC (from Aetna), and like all such changes it requires switching over prescriptions and other coverage. I contacted UHC’s specialty pharmacy Optum RX in mid-January to initiate this process for my son’s next growth hormone refill. That call kicked off a 49 odyssey before I ultimately received his specialty medication. During that laborious period of time:
- Between myself, UHC, Optum UX, our doctors, my HR department, and a third-party health advocate, 15 different people were involved trying to negotiate this refill in multiple calls and emails.
- Before I was able to arrange assistance from the health advocate, I was having to take paid time off (PTO) from work in order to spend time on the phone.
- We burned thru 6 prior authorization (PA) request attempts and 1 emergency appeal. Each took several business days to process, where I would sit and wait for feedback before starting the process again and again.
- We ultimately secured approval for a medication that was on their formulary all along. In other words, I had to fight just to get a medicine I entitled to my our insurance contract!
The reason for all of the above pain is because UHC was unwilling to authorize.the specialty medication until we had submitted enough clinical information to their liking.
Despite being in the lowest 5% height percentile his entire life, completed the testing necessary to show his pituitary gland indeed had issues, and having been on a consistent monthly growth hormone therapy regimen for the past 5 years, UHC wanted my son to prove that he really needed it — they demanded he resubmit himself to all of that same testing and provide not one, but two consecutive pituitary gland stimulation tests. Such tests are exhausting in-patient procedures where your child fasts, is hooked up to an IV all-day in a hospital, and has their blood & tested hourly. And UHC wanted him to do that shit twice. You know, just to be sure....
Both of my son's doctors — his pediatrician and pediatric endocrinologist — told UHC all of the above, even submitting his full medical history, but UHC didn’t believe them until the bitter end, when they finally accepted an emergency appeal and gave him his medicine.
We now have the medication in hand — yet we still cannot administer it. Because UHC refused to fill his prior brand, which came packaged in pre-filled injector pens, he is now prescribed a completely-new brand that comes in cartridges which require mixing & administration using a special injector that cannot use until we’ve received in-person training. So while we await a callback to schedule that appointment with the drug's manufacturer (person #16 invited to this party), the clock still ticks.
In the meantime, the above process was compounded by several additional issues:
- A reason for so many PA requests was because we bounced around trying to fill 3 different medications, including wasting time trying to fill the one he had been taking. It wasn't until deep into the process before Optum RX got around to telling us it wasn’t on the formulary. I suppose I could have first checked the formulary myself, but this rabbit-hole started when one of their pharmacists mistakenly told me that it was covered when I asked.
- As we jumped from one medication to the next, each required a new call to the doctor’s office to request a new prescription. And because they were for specialty medications, each one required a new prior authorization request, kicking off a fresh process that chewed up several business days each, compounding the timelines.
- At the same time all of this was happening, our pediatric endocrinologist made the decision to convert their practice to a concigere service, meaning they were going private and no longer accepted insurance. This meant that each time I needed to engage their services — such as calling to request each new prescription — I was paying out-of-pocket. Luckily, they provided me some grace knowing that I was in a bad fight with insurance (and doing most of the legwork for them).
- UHC was our second insurance change in three months, as I had changed jobs three months prior in October. With that insurance change, we had to deal with a single (and far less cumbersome) prior authorization request that led to some missed doses at the end of 2024. But now with the UHC complications, we were missing so many dosages during the dwindling time period of my son’s open growth plates.
TL;DR: fuck UnitedHealthcare. Never have I gone through so much pain with an insurance company to get access to what we are entitled to. And having it at the expense of my son is icing on the bullshit cake.
