Denice, a practice manager in her 50s living with rheumatoid arthritis and ankylosing spondylitis, had been managing both conditions with Truxima infusions since January 2022, after several other medications failed. The treatment gave her back her independence—reducing debilitating pain and restoring the mobility she needed to work and live her life.

In May 2024, that stability was disrupted when her rheumatologist’s office could no longer afford to administer Truxima due to insufficient reimbursement from UnitedHealthcare. Denice was forced to move her infusion to a local hospital, where the process was rushed into 90 minutes instead of the usual 4 hours. The result was a severe reaction that left her bed-bound for two weeks—along with a $1,660 bill, compared to her usual $45.60 copay.

Despite 29 phone calls and emails between her provider and UnitedHealthcare over the course of May and June 2024, a single-case agreement request to restore in-network coverage at a safe infusion site went unanswered. Denice faced a choice between unsafe care she couldn’t afford and no care at all.

Referred to Claimable by her rheumatologist, Denice generated and submitted an appeal the same day seeking proper in-network coverage for Truxima infusions at her preferred site of care. Claimable’s appeal emphasized UnitedHealthcare’s failure to resolve the single-case agreement in a timely manner and the direct harm caused by the forced switch to a different infusion site—including a serious health reaction that left Denice bed-bound for two weeks. The appeal demanded that the insurer grant a single-case agreement for ongoing care and reimburse the $1,660 hospital charge.