A mother has expressed feelings of helplessness and anger toward UnitedHealthcare, alleging the insurance company denied coverage for her son's rehabilitation after a motorcycle accident resulted in a severe brain injury.
Peyton Alvarez, 25, was riding his motorcycle in Greenville, South Carolina, on April 28 when he crashed into a tree. Despite wearing a helmet, the collision caused a brain injury that left him unconscious for approximately six weeks. Doctors initially informed his mother, Trina Alvarez, that Peyton might not recover consciousness.
However, in early June, Peyton began to show signs of recovery, opening his right eye and responding to prompts with movement in his left arm and toes. His doctor recommended a transfer to the Shepherd Center in Atlanta, a leading facility for brain injury rehabilitation. The center, which accepts patients with a good prognosis for recovery and requires insurance coverage, accepted Peyton's application.
On July 7, Trina received a denial letter from UnitedHealthcare, stating that Peyton's treatment at the Shepherd Center was considered 'medically unnecessary.' An initial appeal, submitted with the doctor's recommendation, was also denied.
Trina Alvarez stated that UnitedHealthcare's decision is frustrating and angering, suggesting the company prioritizes profit over her son's medical needs. "They make sh** tons of money, and they want to deny his care. It's all about the money. It's not about my son and the medical care that he should get," she told the Daily Mail.
UnitedHealthcare cited Peyton's score on the Rancho Los Amigos scale as a reason for the denial. The scale measures cognitive recovery in brain injury patients, and Peyton was reportedly at a level three. The insurer indicated that a level four would be required for coverage. However, Trina argued that achieving a level four is contingent on the intensive rehabilitation program offered at facilities like the Shepherd Center.
"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," she explained.
UnitedHealthcare, in a statement, expressed empathy for the family and said that Peyton has alternative covered care options offering rehabilitative therapy. "We are ready to work with the family as soon as they make a decision," the insurer stated.
Trina dismissed this as referring to a skilled nursing facility, which she believes would offer only basic care without the necessary rehabilitation. She is now exploring options to transfer Peyton to another facility, potentially the Hermann Hospital in Houston, and is considering paying out-of-pocket or seeking a provider that might cover his care.
An online fundraiser has been established to assist the Alvarez family with medical expenses.
UnitedHealthcare has previously faced scrutiny regarding its insurance claim denials. In late 2024, the company's former CEO, Brian Thompson, was assassinated. His killer, Luigi Mangione, stated his motivation stemmed from frustration with the healthcare system and his inability to obtain coverage for chronic back pain. Trina Alvarez commented that many people likely share similar frustrations with the company's practices.