Mineola father says UnitedHealthcare deems 24/7 home care for disabled son no longer 'medically necessary'
Michael Kelly says his son, Kevin Kelly, has received 24/7 home nursing care for the past eight years due to his complex medical needs, which include hourly medications, respiratory treatments, suctioning and feeding through a specialized device.
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A Mineola father says a recent decision by UnitedHealthcare has left him solely responsible for providing around-the-clock care for his 25-year-old son, who is quadriplegic and relies on extensive daily medical support.
Michael Kelly says his son, Kevin Kelly, has received 24/7 home nursing care for the past eight years due to his complex medical needs, which include hourly medications, respiratory treatments, suctioning and feeding through a specialized device.
But in a letter dated May 27, UnitedHealthcare informed the family that around-the-clock skilled nursing services were no longer considered "medically necessary."
According to the letter, Kevin’s condition is considered stable and coverage was approved for six hours of nursing care per day. The insurer also cited the presence of a “reliable caregiver” as part of its determination.
“Seven days ago, the insurance company told us that Kevin is no longer medically a necessity to have home care,” Kelly said.
Kelly disputes the decision, saying his son’s medical needs require constant attention throughout the day.
“He’s on either a respiratory treatment, a feeding regimen or suctioning every hour from 6 a.m. to 1 a.m.,” he said.
The coverage change comes after health insurance for New York City employees transitioned Jan. 1 from EmblemHealth to a partnership with UnitedHealthcare. Kelly, a retired NYPD officer, said he never encountered a similar issue during his son’s lifetime.
“It’s unconscionable that anybody could think that he is not medically necessary to have home health care,” Kelly said.
Kelly says paying for private nursing care is financially impossible.
“If I was going to pay for nursing myself, it would probably be on an average of about $1,400 a day,” he said.
For now, Kelly says he will continue caring for his son on his own while seeking answers and appealing the decision.
UnitedHealthcare wrote in a statement, "We empathize with families dealing with complex medical conditions and we remain eager to help our members find resolution to any issues they may have. We have attempted to connect with the family to directly address their needs."
