Santa Barbara Surgeon Calls Out Health Insurance Giant

Before he moved to town in 2016, Dr. Kevin Casey served as a Navy trauma surgeon during the U.S.-led wars in Iraq and Afghanistan. Now, when he’s not performing 10-hour surgeries or making his rounds, Casey and his team of billers at Santa Barbara Vascular Specialists do battle with American insurance carriers over their routine denial of care.

Casey is constantly frustrated by the machinations of the private health insurance market, describing it as a fundamentally broken system that prioritizes profits above all else. But the tactics of one particular company ― UnitedHealthcare, the largest health insurer in the United States that reported $448 billion in revenue last year ― have appalled and “enraged” him, he said.

“While their immoral actions are too numerous to state, my most recent interaction with them was inexcusable and exemplifies yet another breach of their contract with patients,” Casey wrote in a letter to the Independent, which was followed this week by an interview.

Casey stated that, in his medical opinion, a long-delayed decision by UnitedHealthcare to approve coverage for an 82-year-old patient “ultimately contributed to her preventable death.” Casey said he was sharing his patient’s story with the permission of her family, who wished to keep their identities private.

Representatives for UnitedHealthcare ― whose CEO last month received withering criticism from a bipartisan panel of Congress over rising consumer costs ― did not respond to multiple requests for comment.

Jane Doe was an active and vibrant member of the Santa Barbara community, Casey said, who, in her later years, suffered from severe peripheral arterial disease. Despite multiple attempts to save her foot, Doe underwent a below-knee amputation in December.

Following the surgery at Cottage Hospital, Doe was discharged to a skilled nursing facility to recover. Five days later, she was readmitted to Cottage for “failure to thrive.” But Doe bounced back, and, several days later, met all the criteria to return to the nursing facility, where she would receive physical therapy and other critical support not available from a hospital bed.

“This is where UnitedHealthcare intervened,” Casey said. The company refused the placement. “Despite continual requests to understand why, no justification was given,” he said. “This is a woman who was a new amputee, had no immediate family to help, and required more intense nursing care than could ever be provided at home.”

Casey’s team spent the following days challenging the denial. They were told they could make a “physician appeal” and would receive a response within 72 hours. Five more days passed with no word from UnitedHealthcare. “Our physicians and social workers called continuously, requesting an answer and were either put on hold indefinitely or blatantly disregarded,” Casey said. “One physician on my team was hung up on after 45 minutes of waiting. … These are busy surgeons trying to do what is best for a patient and do not have time to be on hold that long.”

Meanwhile, Doe was declining. She was growing depressed sitting in the hospital with no sustainable plan in sight. “She felt abandoned,” Casey said, all because she was waiting on UnitedHealthcare to approve a medically necessary discharge to the nursing facility. By all measures, a transfer of this nature would be considered standard of care, said Casey, who currently serves on the board of the Central Coast Medical Association. “Conversely, refusal to do such is blatantly outside of such standards.”

After 26 days, the family’s personal appeal was approved. UnitedHealthcare offered no explanation for their reversal. However, the company then said it had made a paperwork error and Doe would need to wait in the hospital another three days. Finally, Doe was transferred to the nursing facility, but she was considerably weakened and despondent. Shortly thereafter, she died.

“Their strategy is very clear and methodical,” Casey said. “By creating countless hurdles for either procedure approval and/or denial of payment for standard medical care, they ultimately discourage a percentage of physicians and patients from seeking care.” The constant stress of these roadblocks contributes to the burnout plaguing medical providers across the country, he said.

Casey pointed to two other cases of delay involving different insurance agencies that resulted in devastating outcomes for his patients. One needed surgery on his wounded leg. The night before the procedure, coverage was denied. The patient then became septic and passed away. Another patient required treatment for a chronic vascular condition that was similarly denied but later approved. They are still struggling with long-term complications from the delay.

“Years of frustration and anger are finally bubbling over,” said Casey of his decision to speak out now. “We are part of a system that is not working, and we pay into this system. So, you expect to have services that are humane and meet your needs.” Doctors throughout the United States work tirelessly for their patients. “On the other side, you’ve got people who can make decisions without any regard for outcomes,” he said. Oftentimes, those people are not physicians. And sometimes, they’re not even human, with life-or-death calls made increasingly by artificial intelligence. 

Casey took his complaints about UnitedHealthcare and Jane Doe to the California Medical Association and has reached out to elected officials. He said he plans to keep ringing the alarm bell with more stories of “unethical decisions” executed by UnitedHealthcare and other insurance companies.

“I hope other physicians and healthcare providers feel compelled to write in about their experiences as well,” he said. “Our patients have a right to know that this is happening to their friends, their family members, and possibly themselves in the future.”