Universal Health Care of Pinellas Florida

Universal Health Care

150 2nd Avenue N.

Suite 400

St. Petersburg, Florida 33701

Subject: Complaint on Universal Health Care of Pinellas County, Florida

Reference: Refused to authorize cataract surgery on member Mark Van Doren

Dear Sir:

The above reference member wishes to file a complaint concerning his health plan with Universal Health Care.

1. Universal Health Care of Pinellas County of Florida did on November 29, 2006 refused to authorize cataract surgery at The Eye Institute of West Florida on Mark Van Doren.

2. Mark Van Doren is a member of the Medicare Masterpiece Plan UHC ID# MM778310875, & CMS Plan # H5404022

3. The surgery was to be performed on November 30, 2006 at 11:00AM on the “right eye” of Mark Van Doren

4. The said eye has vision of 20/400, legally blind, has caused serious problems in Mark Van Doren personal life as a photographer, and limited Mark Van Doren’s ability to drive at night, to work on the computer, and to read any printed material, because of the glare and hallo affect on Mark’s vision by the cataract.

5. Please see Mark Van Doren’s web site : www.florida-photo-magazine.com as proof of being a photographer. Over 5 million visit the web site including people from 118 countries world wide.

6. When Mark’s vision is split when vision is block on the left eye, and the right eye becomes the primary source of vision, he can not make out any object. For example when pulling into the middle of a four lane highway, and one must look over his right shoulder through one of the side windows of the car, the left eye (the good) eye is blocked, and the primary vision eye is the right (20/400), it’s impossible to determine the speed, distance, of passing cars, thus making it unsafe to pull out into traffic.

7. Universal Health Care made certain representations to induce Mark Van Doren, and Wife, Gloria Van Doren, to join the plan saying, both in sales literature and by their sales representative, and I quote “Hassle Free Health Care”.

Under the above circumstances, Mark’s right eye surgery should have been authorized. I therefore request all payments under my Medicare health plan to Universal Health Care be stopped. That an investigation be made of the plan to determine if members are in fact getting what they were promised.

Mark Van Doren

Gloria Van Doren

49 Lone Pine Ave.

Dunedin, Florida 34698-9656

Telephone: 727-734-3780

E-mail: Email User

http://www.florida-photo-magazine.com/

Comment On This

Mark, this is a copy of some of what I went through. You can complain to the CMS address at the bottom of my letter. Also call Greg Moldin at 850-413-5830. He is with the Florida Insurance Commission that deals with complaints against these criminal enterprises called health insurance companies. DO NOT give up, keep complaining. Let Greg know you talked with me, Gary M. Ruehle and UHC as he is VERY familiar with the problems with them and what I went through. It AIN'T over yet. Gary )^_^)

Monday, May 11, 2009 9:48 AM

From: "ServicePoint AT fldfs.com" <ServicePoint AT fldfs.com>Add sender to ContactsTo: garyruehle AT yahoo.comDear Mr. Ruehle:

We have received a response from both the Center for Medicare and Medicaid Services (CMS) and Universal HealthCare (Universal) regarding your request for assistance. At the direction of CMS, Universal has notified us that they must disenroll you as a plan subscriber. This is do to the extended amount of time you have been out of the service area of your plan. The plan requires that you spend no more than six months out of the service area at any one time. Since CMS has your permanent address listed as your location in Thailand, they have instructed Universal to remove you as a member of the plan.

Universal has denied your claim on the basis that the second surgery to repair your knee was not an emergency. They have taken the stance that the emergency procedures were those services that were performed to stabilize you after you were admitted. Your next course of action will be to file a grievance with CMS regarding the denial by Universal. CMS will perform an independent review of the information provided and make a ruling as to whether or not Universal must pay the claim or uphold their decision to deny the claim. You may send your appeal request to:

Centers for Medicare and Medicaid Services

Division of Medicare

61 Forsyth Street # 4T20

Atlanta, Georgia