Not Romantically Necessary: Prior Auth for Valentine's Dinner, Denied.
She's my wife, but that doesn't seem to matter to UHC.
Program Number: 00006192015
Program Requested: Romantic Dinner w/ Identified Partner
Romance & Tenderness (R&T) Committee
Denial Date Effective Date: February 14th, 2023
1. Background:
UnitedHealthcare Romantic Dinner Scheduling Programs
2022 P 2119-6
Prior Authorization/Romantic Necessity - Lack of Evidence of Evidence-Based Connection
Prior Dates, Dinner:
2/2017, 3/2018, 3/2019, 4/2020, 6/2021, 6/2022
9/1/2022;
Drinks Only: 9/1/2022
Valentine’s Day (Generic: romanceozone) date requested with:
Carlene MacMillan, M.D.
This prior authorization program is intended to encourage the use of lower-cost alternatives. This program requires a member to try two alternative bio-similar romantic partners – Claire Danes or Kristen Dunst— before providing coverage for Carlene MacMillan.
Research demonstrates Claire Danes and Kristen Dunst are appropriate bio-similars for Carlene MacMillan.
2. Coverage Criteria:
A. Dinner on February 14th, 2023 with Carlene MacMillan will be approved based on ALL of the following criteria:
1. Patient has an organic cause of romantic dysfunction [ie: diabetes mellitus, hypertension, atherosclerosis, drug-induced erectile-dysfunction, hypercholesterolemia, renal insufficiency, neurological disease (e.g. stroke, seizure disorder, demyelinating disease, spinal cord injury, tumor), endocrine disorder including hypogonadism, vascular or neurologic disease affecting the genitalia, or history of male genital surgery (including prostatectomy, trauma, or irradiation)]
-AND-
2. Patient is not receiving adequate romantic attention* on prior dates of service-
-AND-
3. History of abject failure, contraindication, or intolerance to two of the following (document a romantic gesture, partner, date tried, and reason for being a total failure):
a. Kristen Dunst (Generic: Blonde)
b. Claire Danes (Generic: Blonde MILF)
c. Stephanie Foley (Generic: Ex-Girlfriend)
-AND-
4. Patient is not concurrently receiving an alternative source of love or affection.
Authorization will be issued for 12 months, Expiring on 2/13/2024. Subsequent Romantic Dates and/or Gestures will require matchmaker-to-matchmaker review.
State mandates may apply. Any federal regulatory requirements and the member-specific benefit plan coverage may also impact coverage criteria. Other policies and utilization management programs may apply.
© 2022 UnitedHealthcare Romantic Management Services
*Examples (not all-inclusive): hugs, coffee dates (e.g. Blue Bottle, Starbucks, Brooklyn Roasting Company), a movie, brunch, breakfast in bed, a sweet text message, plans for the future (e.g. Costa Rica, Time at the APA), olives purchased cause you like them even if she doesn’t, a fragrant bath (e.g. bath salts, bubbles, bath “bombs”, rose petals, water just the right temperature), selective sensitivity enhancement TV shows (e.g. watching the Sopranos, the Wire, South Park, Nirvana documentaries, John Oliver, John Stewart), long walks, fresh squeezed OJ, ordering your meds from Capsule so you don’t forget, tidying up, considerate scheduling, a funny email, knowing looks, lithium carbonate, that cheese we both like, cold brew, understanding, not popping my zits, laughing at my jokes, pushing the elevator button, Pepe’s pizza, Omakase, concerts together (e.g. Radiohead, Modest Mouse, Neutral Milk Hotel).
3. Additional Clinical Rules:
Notwithstanding Coverage Criteria, UnitedHealthcare may approve initial and re-authorization based solely on previous date/romantic history, diagnosis codes (ICD-10) and/or a gut feeling that she isn’t right for you. Use of automated approval and re-approval processes varies by Partner and/or Occasion.
Quantity limits may be in place.1
References:
#220907. September 2006.
3. Mating In Captivity, Esther Perel. 2009.
4. Burnett AL, Nehra A, Breau RH, et al. Erectile Dysfunction: AUA Guideline. American, Urological Association. 2018.
Program Prior Authorization/Romantic Necessity Necessity – Valentine’s Dinner with Carlene MacMillan
Yiftach Roth, Aron Tendler, Mehmet Kemal Arikan, Ryan Vidrine, David Kent, Owen Muir, Carlene MacMillan, Leah Casuto, Geoffrey Grammer, William Sauve, Kellie Tolin, Steven Harvey, Misty Borst, Robert Rifkin, Manish Sheth, Brandon Cornejo, Raul Rodriguez, Saad Shakir, Taylor Porter, Deborah Kim, Brent Peterson, Julia Swofford, Brendan Roe, Rebecca Sinclair, Tal Harmelech, Abraham Zangen, Real-world efficacy of deep and abiding love: Post-marketing data collected from twenty-two romantic encounters,
Journal of Romantic Research, Volume 137, 2021, Pages 667-672, SSN 0022-3956, https://doi.org/10.1016/j.jromance.2017.06.009.
Policy Review Update Change Control (with Review Dates):
Date of Service: 10/2013, Service: New Relationship Trial Onset, Place of Service: Disney World, Orlando, Florida.
7/2015 Annual review. Clarified existing criteria with no change to intent and updated based on a qualifying life event.
4/2016: Augmentation Agents added to regimen to enhance connection: Twin Children( MacMillan Muir Brand Name Only) with escalating age as directed.
3/2019 Changed the required step agents from Rene Zellweger to Claire Danes
and qualifying ex-girlfriend from Ruth Baldwin to generic Stephanie Foley.
Updated references. 4/2020 Updated references and Bio-similar confirmation as per protocol:
6/2021 Annual review. Updated references. 6/2022 Annual review. Updated references.
—R&T Committee Reviewer O.S. Muir, Feb 13, 2023.2
1. Stendra [package insert]. Freehold, NJ: Metuchen Pharmaceuticals, LLC; November 2021. 2. Drugs That May Cause Male Sexual Dysfunction. Pharmacist’s Letter. Detail Document
Hey, a guy has got to work.
I love this substack
Sounds unlikely that Clare Danes or Jennifer Lawrence or whomever would be easily available at a lower cost?