After 30 Years...

This site is meant to provide details on the many struggles I’ve experienced after having surgery for a torn rotator cuff. Being denied over and over the benefits that by contract I was entitled to. And ultimately being terminated when unable to perform my job, after 30 years of hard work and committed service at UPS. 

Very briefly, in 2016, I had been working at UPS for 30 years. I was very hard working, dedicated, punctual, never in trouble. I was proud of the work I did at UPS. And I’m confident that any of my supervisors would say I performed in the top 20% of their employees. 

I’ve worked many jobs in the hub over 3 decades, including loader, pick, small sorter, air driver, hazardous responder. Most recently working in the sort aisle which required lifting packages up to 70lbs at a rate of about one every 2-3 seconds. As anyone who has ever done this knows, the pace of this work is very demanding. And many of these packages had to be lifted and sorted to belts ABOVE SHOULDER HEIGHT. 

At this time I had been married for 11 years, and my wife and I had an eight year old son. Everyone in my family had always been covered by the healthcare plan included in my UPS benefits package. 

I had serious shoulder issues that June. I sought medical treatment, and went on short term disability. I was eventually referred to a specialist, at which time it was determined that I would need surgery to repair a torn rotator cuff. 

I did have that surgery, and Teamcare handled my short term disability. Initially, everything went rather smoothly. It wasn’t until the short term disability ran out and I needed to transition to long term disability with Aetna that I started having MAJOR PROBLEMS RECEIVING THE HEALTHCARE SERVICES DUE TO ME per my UPS benefits package. 

My short term disability benefits were set to expire in December. But this document from my surgeon indicates that I would need to be off work well beyond that date. 

So by January I had been going to physical therapy appointments for my shoulder on a regular basis. 

My wife had several medical issues, and she’d been doing what she needed to in order to manage them. She is epileptic and must see a neurologist regularly. She does require medication daily for this. She was being treated for severe migraines, in addition to some neck and back problems. And at the time she was also seeing a psychiatrist and taking medications for depression and anxiety issues. 

Then my son had kind of a freak accident at school and suffered a concussion. It was months before we saw any improvement in his condition, which was VERY scary. We were taking him to see traumatic brain injury specialists. And he was in therapy for both physical and cognitive issues (thankfully, he did have a full recovery).

The following document shows the days my son missed school due to his head injury.

Soon after this, I received a COBRA notice from Teamcare saying I had the right to purchase continued health care coverage. This made no sense since I was off work for an approved medical reason. And per my UPS contract, I was entitled to continuing health care coverage at NO COST TO MYSELF. Not to mention the fact that they were asking me to pay $399 PER WEEK for something that was already a part of my UPS benefits package.

Around this time, I had doctor’s appointments coming up. I had physical therapy appointments. My son had appointments. In addition to her other appointments, my wife had a medical procedure scheduled. And not only are we finding out we have no insurance, but NOBODY SEEMED TO BE ABLE (OR BE WILLING) TO DO ANYTHING TO HELP. What do we do? Keep going to appointments not knowing if they’re going to be covered by insurance anymore? I couldn’t work with my shoulder in the condition it was in, and we were already falling behind on bills with just my wife’s income.

I then contacted Kyle Weldon (the UPS Business Rep) from Teamsters Local 20 to see if the union could help resolve these ongoing issues. I called him and began explaining the problems I’d been having with my benefits. He told me he didn’t really have time to talk to me, but asked that I email him about what’s going on. So I did send him multiple emails over the course of a couple weeks. I explained the situation and also sent him a number of documents that I had both sent to and received from Aetna. Kyle never responded to any of my emails, although he did eventually call me back and say he would have someone (Jackie) from Teamcare get in touch with me soon to help out.

Below is a message I sent Kyle at the Teamster's Local 20 describing the issues I was having and asking for his help.

So I again contacted Kyle at Teamsters Local 20 let him know I did hear from Jackie at Teamcare. And she let me know that short of me paying $399 per week for COBRA, there wasn't anything she could do to help the situation. But I didn’t hear anything back from Kyle.

We started hearing from more and more medical providers saying TEAMCARE WAS TAKING BACK THE MONEY THEY HAD ALREADY PAID. It became obvious that any money paid earlier in the year would eventually all be taken back. And we were now going to be held responsible for those thousands and thousands of dollars. We were getting calls and letters from more and more providers wanting money for past services.

It was the beginning of April, and I had been getting nowhere with Aetna on the phone (or anyone else for that matter), so I decided to submit a letter explaining the situation and asking for help. I thought unlike all my phone calls, if there was an actual letter explaining the situation attached to the case, it couldn’t be ignored. Keep in mind at this point I’ve sent multiple medical documents to both UPS and Aetna. And I’ve called Aetna, UPS, and the Teamsters multiple times asking for help with my claim. Still, the only communication I’d received from Aetna was the letter back in December when they told me I didn’t have to do anything. They have all the information they need. And they’re here to help. It’s been nearly 4 MONTHS AND I HAVEN’T RECEIVED A DISABILITY PAYMENT. My family's insurance is cancelled. And Teamcare is taking back medical payments already made. On top of our family having to deal with multiple medical crises, we now had a quickly growing financial crisis.

So early in April, I submitted my letter to Aetna. I explained that I’m not receiving the long term disability benefits I’m entitled to. And I mentioned the problems I’d been having with my claim and that I had sent Aetna a message asking for help. I stated that after 6-7 weeks, I’d still had no response from Aetna.

Weeks start going by again without any kind of response from Aetna. Keep in mind, this is a time when WE ARE BEING DENIED OUR MEDICAL INSURANCE. We are in need of medical services. And we are getting calls and letters asking for payments for medical services that had previously been paid by insurance but subsequently were reversed. It made it very difficult to continue with most of our medical appointments. I had to stop going to my physical therapy appointments (my prescribed course of treatment) due to a lack of insurance. My wife also stopped her therapy appointments when Teamcare started taking back payments. Most of our medical providers didn't want see us until the insurance issues were resolved. And we just keep getting THOUSANDS AND THOUSANDS OF DOLLARS WORTH OF BILLS in the mail.

Then early in May, a full 4 weeks after my most recent request to Aetna for help resolving the situation, I receive a letter from them. The letter is from Jonathan Cruz, who I’m guessing was the person who had been (mis)handling my case for the last 4 months. In this letter (which is the first time he’s contacted me) he states that I AM RESPONSIBLE for my own healthcare benefits coverage. He says I HAVE TO PAY for my own insurance. And if I don’t pay, my benefits will be terminated. Will be terminated? I’ve been telling Aetna for months my benefits were terminated when THEY SHOULDN’T HAVE BEEN! I’ve been calling Aetna, I’ve been sending messages to Aetna, and I’ve submitted documents to Aetna both explaining that I should be on long term disability, I should have healthcare coverage, and asking for help. Asking what I need to do to resolve this. After 4 months with us unable to pay for treatments, unable to pay for therapy, and with bills piling up, I get a letter from Jonathan at Aetna telling me I’M NOT ENTITLED TO ANY HEALTHCARE BENEFITS?

At this point it’s been over 2 months since I’ve been to my prescribed physical therapy appointments due to lack of insurance. Keep in mind that Teamcare has taken back payments for my physical therapy earlier in the year. The therapist’s office WOULD NOT SCHEDULE ME FOR ANY MORE APPOINTMENTS until the insurance starts paying them again. So as long as my health insurance is being denied, I am effectively being denied the course of treatment prescribed by my physician. As long as Aetna was not approving me for Long-Term Disability, and UPS WAS NOT SUBMITTING PAYMENTS FOR MY INSURANCE, I couldn’t receive all the healthcare services I needed.

The middle of May, I uploaded another letter to Aetna in response to the one I had received from Jonathan Cruz. I explained that I’ve been trying for months to find out what needed to be done to get my desperately needed healthcare insurance reinstated. And Aetna hasn’t yet responded to any of my requests for help.

I included a page from the UPS Master Agreement stating that I am entitled to long term disability benefits. I wanted to make it very clear to Aetna that I WAS ENTITLED TO THE BENEFITS THEY HAD BEEN DENYING ME for so long.

My job required frequently lifting 50lbs or more at shoulder height. And required that a rapid pace to be maintained.

The orthopedic surgeon’s office sent new paperwork into Aetna. This stated that I needed to remain off work, and would be returning to his office for a repeat steroid injection.

Luckily, the orthopedic surgeon hadn’t stopped seeing me due to lack of payment. But that wasn’t the case for most of our family’s medical providers. WE WERE RECEIVING BILLS, LATE NOTICES , and calls from medical providers who were waiting for payments. Some providers had insurance payments already made which were subsequently taken back from them. These went back as far as six months and totaled THOUSANDS AND THOUSANDS OF DOLLARS. Our physical and mental health was being greatly impacted by the denials and lack of service from both doctors and therapists. And also by our deteriorating financial condition. Our prescription medications were no longer being covered. 

There was nothing we could do but wait and hope that after contacting so many people and getting nowhere, Lashawn would be the one who would finally get our insurance restored and we could finally continue with the healthcare services we so badly needed.

It had been two weeks since I called Lashawn at Aetna and left a message for her explaining that I was still having shoulder problems, that I had an upcoming appointment with Dr. Narra, and that I NEEDED TO EXTEND MY LEAVE.

Then on Friday, July 14, I received notice from Aetna that MY FILE HAD BEEN CLOSED! That I’m only entitled to benefits through 7/19 and that NO FURTHER BENEFITS ARE DUE. This letter came from Lashawn. The same person who just a couple weeks prior, I had left a message for letting her know that I HADN’T HAD IMPROVEMENT WITH MY SHOULDER and I needed to extend my leave.

I had no Idea what she was talking about. Dr. Assenmacher had NEVER CLEARED ME TO RETURN TO WORK! I hadn’t seen him since 6/26. And the last note I had from him had me remaining out of work until I was able to see Dr. Narra. Definitely not cleared to return. Both UPS and Aetna were informed about my upcoming appointment with Dr. Narra. It was well known to Aetna, UPS, Dr. Assenmacher, and Dr. Narra that I STILL HAD CONTINUING SHOULDER ISSUES. I was always in communication either by phone or submitted documents. So I couldn’t believe that this could be anything but yet another huge mistake.

All this happened on a Friday, so the following Monday morning I contacted Dr. Assenmacher’s office to figure out just what was going on. I told them that Aetna was saying the doctor had released me to return to work. I spoke directly to the person in the office who talked with Aetna on the previous Friday. She told me THEY NEVER RELEASED ME TO RETURN TO WORK, and she was surprised when I told her that’s what Aetna was saying.

She did go on to tell me that the Aetna representative DIDN’T LIKE THE WORDING of the doctor’s note they had provided earlier having me off work through my upcoming appointment with Dr. Narra. And she told me the doctor’s office was ASKED BY AETNA TO CHANGE THE WORDING, which they did. This is the revised note.

My family and I had been waiting for about half a year for our insurance to be reinstated. Waiting to get back to the various treatments and therapies we all needed. While we waited we were becoming deeper and deeper in credit card debt. I was continually asking over and over both on the phone and through submitted letters what I could do to help get this issue resolved. 

When my claim finally showed up on the Aetna website, it was listed as “pending” for several months (which effectively means you don’t actively have any benefits). Until July 14 when I received notice it was “closed”. It was never at any time listed as approved. What this means is that in the year 2017, the only time my family and I actively had health insurance was from July 14 to July 19. That’s the date my case was closed to the date Lashawn says I was no longer entitled to benefits. For the entire year, that’s LESS THAN A WEEK THAT WE ACTIVELY HAD ACCESS TO OUR HEALTHCARE BENEFITS. Less than a week. Less than a week that my family could actually seek treatments while having our insurance active.

It seems as though Aetna used the wording change from “should” to “will” as an excuse to close the file. AT NO POINT WAS I EVER RELEASED TO RETURN TO MY ESSENTIAL JOB FUNCTION as claimed by Lashawn at Aetna. Just the opposite. The note sent by the doctor to Aetna on 7/14 explains that I WAS NOT RECEIVING ANY RELIEF. 

Not to mention the fact that I had informed Aetna in writing and by phone, in addition to Dr. Assenmacher’s office letting Aetna know that I had an upcoming appointment with Dr. Narra for these ongoing issues. But it would seem Aetna’s concern was in closing the case and not ensuring that I get the treatments I needed. I’D BEEN WAITING ALL THIS TIME TO GET MY INSURANCE REINSTATED so I could get back to my rehab, and I was now being informed the file is being closed.

So after contacting Dr. Assenmacher’s office, and not understanding why Aetna chose to close my file, I submitted a letter to Lashawn at Aetna explaining once again that I hadn’t had significant improvement in my shoulder, that I had an upcoming appointment with Dr. Narra, and that I needed to know what to do in order to extend my leave.

There was no response from Aetna on that day. The following afternoon I went to my appointment with Dr. Narra. At this point, I HADN’T BEEN TO PHYSICAL THERAPY FOR 5 MONTHS due to my insurance cancelation. He wanted me to get back into therapy right away, and he wrote an order for it. He also wrote a note having me off work until my next appointment with him in August.

After my appointment with Dr. Narra I uploaded all documents having me off work, ordering X-rays, and ordering physical therapy to Aetna. I also contacted UPS HSRC with the same information. But once again, I was in the same position that I’d been in for the last 6 months. I had no way to pay for my or my family’s healthcare needs as Lashawn at Aetna had immediately closed my file. EFFECTIVELY LEAVING ME WITHOUT INSURANCE AGAIN beginning the very next day after my appointment.

I had been trying to get ahold of Lashawn at Aetna on the phone for several days. I finally ended up speaking with her. But SHE HAD NO INTEREST IN DOING ANYTHING TO HELP. I told her I’d been trying to add time to my leave, and asked her how I should go about that. She told me SHE CAN’T ADVISE ME ON THAT. Can’t advise me? She’s the one that was supposed to be helping my through all this. She went on to tell me she’s closed my file, and TOLD ME NOT TO SEND HER ANY MORE DOCUMENTS. She let me know she’s just flat out not going to do anything to help me to get the benefits my family needed. She’s disregarded what I’ve been telling her and what the doctors have said, and just closed the case. How did Aetna ever expect me to heal when all they did was consistently deny me any ongoing coverage for treatments?

I’d been fighting so long in an effort to get the healthcare I WAS ENTITLED TO. I’d been pleading with people to try and get the healthcare may family desperately needed. I WASN’T ASKING FOR ANYTHING MORE THAN THE BENEFITS DUE TO ME per the UPS contract. But most of the people paid to “help” were little or absolutely no help at all. This had all taken a huge toll on my whole family for such a long time. 

After half a year of uncertainty, struggle, and both mental and financial strain, we thought it was about to be over. We thought Aetna was finally working on the case and we’ll finally have our medical insurance back soon. But all they did was let us think everything was going to be okay, only to then pull the rug out from under us.

For the year, we went from not having medical insurance because we’re not entitled to any medical insurance (as Jonathan at Aetna falsely claimed in his letter), to acknowledgement that we’re entitled to medical insurance but we don’t have any because the case is still pending, to we don’t have any medical insurance because the case is now closed, and we aren’t going to give you anything you need going forward.

We had certain HEALTHCARE PROVIDERS AND THERAPISTS THAT WOULDN’T SEE US anymore because of outstanding balances. There were treatments we hadn’t received, just waiting for this all to be resolved. I couldn’t afford the physical therapy I was supposed to have for the last 5 months, let alone to have the physical therapy and imaging done that my doctor was currently prescribing going forward. So what do we do now? Aetna was not going to do anything to allow us the treatments we needed and had been waiting so long to receive. SIX MONTHS OF LETTERS AND DOCUMENTS AND PHONE CALLS to Aetna, UPS, Teamsters, and Teamcare had gotten us absolutely nowhere. It was completely draining, both MENTALLY AND EMOTIONALLY.

I again contacted UPS HR about the situation, and Aetna did eventually approve and pay for the previous medical expenses we had for the year, but only those up to July. NOTHING GOING FORWARD! BUT GOING FORWARD WAS WHAT WE NEEDED SO BADLY. It’s what we’d been waiting for all this time. It’s great that they did finally pay the past medical expenses. I say great, even though those were actually benefits due to us and should have been paid months earlier. That was supposed to happen. But what WE REALLY NEEDED ALL THIS TIME WAS HEALTHCARE SERVICES GOING FORWARD in order to improve, to get better, to heal. That was something never given to us.

Just a couple weeks later, MY WIFE TRIED TO TAKE HER OWN LIFE. Not knowing what had happened, I found her on the floor in our bedroom with her body twisted. Her eyes were rolled back in her head and she was having a seizure. I tried talking to her, but it was as if she didn’t even know I was there. I called 911, but I don’t know if I was even making any sense. It was such an incredibly scary moment. The fire department did arrive, and she was taken to the emergency room, where we spent the night. She had regained consciousness (for lack of a better word). And it was at this time I learned that she had taken upwards of 30 pain killers in an effort to kill herself.  The following morning she was transported to the psychiatric care unit where she was held for several days. I was only allowed very limited visits with her.

I wasn’t given much time to respond, so I emailed Mr. Lawniczak on January 18. I briefly explained to Todd that I was STILL EXPERIENCING SHOULDER PROBLEMS. That I was not receiving the treatments and diagnostics my doctor prescribed due to insurance issues. That I was BEING DENIED BENEFITS DUE TO ME. And that I was looking to resolve ongoing disability issues with Aetna. I gave my email address and I asked Todd to PLEASE CONTACT ME.