A mother has said she feels ‘helpless’ and called UnitedHealthcare money-hungry after the insurance company allegedly denied covering her son’s rehab for a brain injury.
Peyton Alvarez, a 25-year-old airline mechanic at PSA Airlines, crashed into a tree while riding his motorcycle in Greenville, South Carolina, on April 28.
Although he was wearing a helmet and other protective gear, the collision caused a serious brain injury that left him unconscious for a month and a half. Doctors told his mother, Trina Alvarez, that Peyton may never wake up.
But the young man eventually opened his right eye in early June, and he can move his left arm and wiggle his toes when prompted, Trina told the Daily Mail.
Peyton’s mom submitted a claim with her son’s insurance plan, managed by UnitedHealthcare through his employer, and she made the arrangements to have him transferred to the Shepherd Center in Atlanta, a top brain injury rehabilitation facility.
But on July 7, Trina was crushed when she received a denial letter from UnitedHealthcare, which stated that Peyton’s treatment at the facility was ‘medically unnecessary.’
‘It is so frustrating. It makes me so angry that they can control what happens with my son because the longer he stays at the hospital he’s at, the less chance he has to wake up,’ Trina told the Daily Mail.
‘When you push a parent to the point of feeling like they are helpless, and may contribute to whether their son may ever be able to talk or move his arms and legs or sit up on his own, that should not be allowed,’ she added.
Trina Alvarez (left), the mother of Peyton Alvarez (right), 25, said she feels ‘helpless’ after UnitedHealthcare allegedly denied her son’s coverage. Peyton is pictured before his crash
Peyton suffered a brain injury in an April 28 motorcycle crash, but he was allegedly denied care at a top rehab facility because UnitedHealthcare deemed it ‘not medically necessary’
‘UnitedHealthcare is one of the biggest insurance companies. They make sh** tons of money, and they want to deny his care,’ Trina said.
‘It’s all about the money. It’s not about my son and the medical care that he should get,’ she added.
When Peyton opened his left eye and showed that he could still make small movements, it was a ray of hope for his anguished mother.
It was the young man’s doctor who recommended that he be transferred to the Shepherd Center, and when Trina’s application to have her son treated there was accepted, that marked another moment of hope.
The selective facility only accepts patients with a good chance of at least partial recovery, and around 85 percent of those who are admitted to the program experience improvement in their condition, Trina said. It also only accepts patients covered by insurance.
So when UnitedHealthcare denied Peyton’s initial claim, and then also denied an appeal Trina submitted with documentation of the doctor’s recommendation, the mom was utterly devastated.
UnitedHealthcare came under scrutiny for denying insurance claims after its former CEO, Brian Thompson, was assassinated in late 2024.
Thompson’s killer, Luigi Mangione, recently admitted in court that he was motivated by his frustration and anger at the healthcare system after being unable to receive coverage for chronic severe back pain.
UnitedHealthcare was scrutinized for denying claims after its former CEO was killed. The killer, Luigi Mangione (pictured), cited anger at the healthcare system as his motivation
Trina said: ‘There’s probably so many people that have felt the same way as [Mangione].’ A sticker protesting UnitedHealthcare outside the courtroom for Mangione’s trial is pictured
Trina emphasized to the Daily Mail that she would never condone killing anyone, but ‘there’s probably so many people that have felt the same way as the guy that actually shot the CEO.’
‘[UnitedHealthcare is] the biggest insurance company,’ she said. ‘They’ve made the most money, and they’re the most commonly denying this kind of cr**.’
Trina explained that UnitedHealthcare justified denying Peyton’s treatment at the Shepherd center because he is at a three on the Rancho scale, a clinical measure of cognitive recovery for patients with brain injuries.
It is indeed common for insurance companies to deny rehab coverage for patients at a three on the scale, as their clinical measures for providing claims are rigid. Trina said that UnitedHealthcare wanted her son to be at a four to qualify for coverage.
‘But the problem is, getting him to a four is dependent on him getting in the [Shepherd Center] program. That’s what they do is get them further,’ the mom told the Daily Mail.
She added that over the past few days, Peyton has been awake for hours at a time and holding his head up on his own.
‘I know that the more stimulation he gets, the better he’s getting,’ Trina said, emphasizing that the sooner he gets the treatment he needs, the likelier he is to have a more significant recovery.
In a statement to the Daily Mail, UnitedHealthcare said: ‘We empathize with the Alvarez family during this incredibly difficult time.
Trina said that UnitedHealthcare wants to put her son in a skilled nursing facility, but she refuses to compromise on his care. Peyton is pictured petting a puppy before his accident
Trina said she is now looking into sending her son to a different hospital in Houston and paying out of pocket. Peyton is pictured at graduation before the accident
‘Based on the clinical information we have, Mr. Alvarez has alternative full-time care options covered under his plan that can provide rehabilitative therapy. We are ready to work with the family as soon as they make a decision.’
Trina scoffed at that reply and said that the ‘alternative’ option UnitedHealthcare referred to was putting Peyton in a skilled nursing facility.
‘They said a skilled nursing facility was a middle ground. That was our compromise,’ Trina told the Daily Mail. ‘When would anybody be okay with compromising on their son’s medical treatment?’
‘If he goes to a skilled nursing facility, all they’re going to do is make sure he doesn’t starve to death and keep him clean,’ she said.
Trina told the Daily Mail that she has been looking into having her son transferred to the Hermann Hospital in Houston, another top brain injury rehab, and potentially paying out of pocket.
If treatment at the facility brings him to a four on the Rancho scale, he may then qualify for coverage under UnitedHealthcare’s plan, but Trina said she is also looking into swapping providers because the hospital told her other companies might pay for his care.
An online fundraiser has been organized to help Peyton’s family cover out-of-pocket medical expenses.
