UniCare / PacifiCare Health insurance Rip-off After merger family threatened, UniCare not to honor insurance. 4 year olds life threatening needs, Family put through Hell forceing Bankruptcy

March 28, 2000

BadBusinessBureau.com
PO Box 310
Tempe, AZ 85280

RE: Adam Nicholas Mathers, Age 4

Dear Sir:

We request your assistance in saving our 4-year-old son's life.

Adam was born June 1, 1995. It was obvious from the beginning that he wasn't a very healthy child. At 7 months of age, I stopped breastfeeding Adam and he became very ill, first with chronic ear infections, then with chronic sinusitis. X-rays showed his sinuses to be totally occluded. No antibiotic would touch his infection. Then he began having sleep apnea. A CT scan showed his adenoids were swollen to the size of walnuts. 2 surgeries later, he was doing a little better, but far from healthy. With the help of Adam's pediatrician, Dr. Richard
LaMere, Fort Worth, TX, Adam was referred to an immunologist, Dr. Elisa Lange, in Dallas, TX. Dr. Lange ran extensive tests, which showed Adam to have Primary Immune Deficiency (IgA and IgG Subclass 2 & 4 deficiency). In other words, Adam is lacking important antibodies in his blood and mucosal surfaces to fight off bacteria.

Since December 1996, Adam has been receiving intravenous gamma globulin to replace missing antibodies, but the replacement is temporary, so he must receive these IV's every 3-4 weeks. The infusions are quite expensive, currently $1265.00 each. Adam must visit his doctors regularly, and he takes prophylactic antibiotics to fight off the bacteria other peoples (your body and my body) bodies fight off without difficulty. He has developed Chronic Reactive Airway Disease as a result of this deficiency, so he also must use inhalers and nebulizer
treatments for breathing. We live in fear of the day he may receive an infection that he cannot recover from.

Our problem concerns insurance. We were on Harris HMO for several years, without difficulty, but due to the buyout with PacifiCare, we were told that our current benefits could not be guaranteed. We did much research, and chose to switch to UniCare PPO. Little did we know that this would be one of the biggest mistakes of our lives.

UniCare is refusing to cover Adam's infusions. We have disputed and now have been denied a 3rd time. Adam may die without these treatments, and we are scared to death of losing our son. We don't understand how UniCare can be allowed to "legally MURDER our child." We have filed a complaint with the TX Dept. of Insurance, and the Director of Benefits at Harris Hospital (where my husband works), but the wheels turn slow, too slow considering what's at stake -- Adam's life.

In the meantime, Adam's home health agency, Coram Healthcare in Dallas, is requiring us to pay for his infusions -- up front, in cash. We live almost from paycheck to paycheck, and now are looking at having to sell everything we own to keep Adam alive. How can UniCare get by with doing this? They hold $108.00 every 2 weeks out of my husband's paycheck for insurance coverage, but UniCare denies EVERY claim sent to them. How
can this be legal?

What we are asking from you is, if you would please, send a letter in Adam's behalf demanding coverage for all future infusions, plus reimbursement on all claims they have denied since 1-1-2000. We also want reimbursement for all of our "out of pocket expenses" to the doctors and home health agency due to UniCare's refusal to pay. The address is:

UniCare
Attn: Danielle Hagan
Two Paces West
Suite 600
2727 Paces Ferry Road, N.W.
Atlanta, Georgia 30339-0044

I'm enclosing copies of letters from Adam's doctors.

We thank you in advance for your assistance.

Sincerely,

Kenneth & Virginia Mathers
313 N.E. Michael Drive
Burleson, TX 76028


Following are the included letters from Adam's physicians.


March 8, 2000

RE: Adam Mathers DOB 6-1-95

To Whom It May Concern:

Adam Mathers has been a patient of mine since October 1995. Starting at nine months of age, he was in my office for several occurrences of sinusitis and otitis media, which never cleared and required frequent treatments. He was also on Nutramigen for milk/soy allergy during his first year of life. Testing was done in July 1996 showing him to have IgA deficiency. At that time he was referred to Dr. Elisa Lange in Dallas who is an immunologist. Several allergy tests were performed
and medications tried by Dr. Lange. And, in November l996 recinnebded IVGG. This therapy has been continued under the care of Dr. Lange. Adam's health has been much improved.

Respectfully,
Richard G. LaMere, M.D., F.A.A.P.
Cook Children's Physician Network
Primary Care Services
1500 West Lancaster, Suite 101
Fort Worth, Texas 76102
Phone 817-870-2910



February 9, 2000

Re: Adam Mathers
DOB: 6-1-95

To Whom It May Concern:

Adam is a four and one-half year old patient of mine with common
variable immunodeficiency and reactive airways disease. Triggers of reactive airways disease include repeated sinusitis and otitis.

He has a history of three episodes of croup and bronchitis during
November 1999, to December 1999. Adam also had episodes of sinusitis monthly from December 1998, through April 1999, as well as one episode of bilateral otitis media.

Adam has improved over the last year with the treatment of intravenous gammaglobulin. His immunoglobulins from July 1996, revealed an IgG of 564, and an IgA of 12, which is low (normal value of 14 to 106), and IgM of 120, which is normal.

Lab work from November 1996 revealed a low IgG2 subclass of 32 (normal 30 to 250), and an IgG4 subclass of 1 (normal to 60). Intravenous gammaglobulin therapy was initiated in December, 1996. In August, 1998, the IgA decreased to 7 (consistent with common variable immunodeficiency). The IgG was normal while on gammaglobulin.

With his recurrent infections, his low IgG sublasses and IgA, and his improvement with intravenous gammaglobulin, I continue to recommend ongoing intravenous gammaglobulin at a dosage of 10 grams every four weeks.

Do not hesitate to call my office if further information is required.

Sincerely,
Elisa B. Lange, M.D.
Asthma & Allergy Specialists of North Texas, P.A.
Presbyterian Heart Institute
8440 Walnut Hill Lane, Suite 350
Dallas, Texas 75231
214-373-1773, Fax 214-373-1316
6300 West parker Road, G21
Plano, Texas 75093
972-608-3370, Fax 972-608-3371