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UnitedHealthcare denies motorcycle crash victim brain injury rehab
UnitedHealthcare said inpatient brain injury rehabilitation was not medically necessary and offered a skilled nursing facility instead, according to a denial letter.
- UnitedHealthcare denied coverage for rehabilitation therapy for Peyton Alvarez, labeling him "Rancho Level 3 but medically stable" and deeming inpatient care not medically necessary.
- Peyton, a mechanic for PSA Airlines, crashed his motorcycle on Perimeter Road in April; despite wearing a helmet, he suffered a traumatic brain injury.
- The Shepherd Center accepted Peyton for intensive rehabilitation, but UnitedHealthcare suggested a skilled nursing facility as a "middle ground," arguing physician approval does not guarantee medical necessity.
- Trina Alvarez, his mother, vowed "I can't stop fighting for my son," while the family explores out-of-pocket payment options for treatment.
- According to the International Brain Injury Association, one million Americans suffer traumatic brain injuries annually, with 80,000 inheriting related disabilities reflecting long-term support needs.
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UnitedHealthcare denies motorcycle crash victim brain injury rehab
Peyton Alvarez was denied coverage for long-term acute care and rehabilitation at the Shepherd Center after suffering a traumatic brain injury in April. His insurance company and employer said his requests did not meet the criteria for coverage.
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