Mother Says She Feels Helpless After UnitedHealthcare Denies Son’s Coverage

A mother says she feels “helpless” and has accused UnitedHealthcare of putting profits first after the insurer allegedly refused to cover rehabilitation for her son’s traumatic brain injury.

Peyton Alvarez, 25, an airline mechanic with PSA Airlines, was riding his motorcycle in Greenville, South Carolina, on April 28 when he crashed into a tree.

Despite wearing a helmet and protective gear, Peyton suffered a severe brain injury in the collision and remained unconscious for about six weeks. His mother, Trina Alvarez, said doctors warned her that he might never wake up.

In early June, however, Peyton opened his right eye. Trina told Our News Outlet that he can now move his left arm and wiggle his toes when asked.

Trina filed a claim through her son’s employer-sponsored insurance plan, which is managed by UnitedHealthcare, and arranged for him to be transferred to the Shepherd Center in Atlanta, a leading rehabilitation hospital for brain injury patients.

But on July 7, she said she was devastated to receive a denial letter from UnitedHealthcare stating that Peyton’s care 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 Our News Outlet.

“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.

‘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. 

Trina emphasized to Our News Outlet 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 Our News Outlet.

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 Our News Outlet, UnitedHealthcare said: ‘We empathize with the Alvarez family during this incredibly difficult time.

‘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 Our News Outlet. ‘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 Our News Outlet 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.