United Healthcare, PSA Airlines deem traumatic brain injury treatment ‘not medically necessary’ for Upstate patient
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Updated: 9:35 PM EDT Aug 20, 2026Editorial Standards ⓘ
Caitlin Ashbaugh
Reporter
United Healthcare, PSA Airlines deem traumatic brain injury treatment ‘not medically necessary’ for Upstate patient
Updated: 9:35 PM EDT Aug 20, 2026Editorial Standards ⓘ
Caitlin Ashbaugh
Reporter
GREENVILLE, S.C. —
The family of a traumatic brain injury patient is seeking out-of-pocket care after his insurance company and employer deemed his requests for rehabilitation and long-term care “medically unnecessary.”
According to the accident report, Peyton Alvarez, 25, was riding a motorcycle on a windy stretch of Perimeter Road in April. He veered off the road and hit a tree
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Despite wearing a helmet, the impact was detrimental and he suffered a traumatic brain injury
“April the 28th, I was getting ready for work, and my phone rang. ‘We have your son Peyton, and he’s been in a motorcycle accident.’ And I was like, oh my gosh, it’s like your worst fear,” His mother, Trina Alvarez, said
His mother said he rebuilt the bike he was riding when he wrecked it from mere pieces in the family’s garage
“The bike was in so many pieces. It was that way for a week or so. But yeah, it all got put back together,” Trina said
Peyton was an airline mechanic through PSA Airlines. His family and friends said he enjoyed working on anything he could get his hands on. Since the accident, his tools sit on shelves and boxes untouched
“They told me there was a very good chance that he may never regain consciousness,” Trina said
After roughly two weeks, Peyton’s eyes opened. He began responding to cues by moving his hand or trying to speak
“I started crying. When I was talking to him, I knew he could hear me,” Trina said
The family, at the recommendation of Peyton’s doctors, reached out to the Shepherd Center in Atlanta, which specializes in rehabilitation for brain injuries
“They don’t accept everyone. She called the next day and said, ‘Yes, we’ll take him.’ We had already had transport set up from an ambulance going to North Greenville to Shepherd,” Trina said
“They sent it through the insurance company. And immediately the next morning, we have a denial that…”
“it was not medically necessary.”
A spokesperson with United Healthcare told WYFF News 4 a skilled nursing facility would be covered by his health plan and would be a “middle ground” between the Long Term Acute Care Peyton was receiving and the rehabilitation requested
Both Trina and Peyton’s hospital staff appealed the decision, citing risks for complications with his recovery
In repeated denial letters, the insurance company and employer upheld the decision
A spokesperson for United Healthcare offered the following statement in regard to Peyton’s coverage for care:
We empathize with the Alvarez family during this incredibly difficult time. Multiple levels of review, including an independent review by a physical medicine specialist, confirmed that Mr. Alvarez’s current condition does not meet the criteria for coverage of the requested level of inpatient rehabilitation therapy. The Alvarez family has a dedicated case management team offered by Peyton’s employer, who will continue to work with his family to evaluate options for his ongoing care
PSA Airlines did not respond to our request for comment
“Shepherd won’t take out-of-pocket funds for their disorder of consciousness. They said years back they used to take out-of-pocket funds and people would spend thousands and thousands of dollars and their loved one wouldn’t wake up,” Trina said
“At Shepherd Center, we’re committed to working with families, care providers, and health insurance companies to ensure patients receive the care they need, and self-payment is accepted for specific diagnoses and programs, as appropriate
Shepherd Center offers comprehensive rehabilitation, research, and family support for people and families experiencing the most complex conditions, including spinal cord and brain injuries, multi-trauma, traumatic amputations, stroke, multiple sclerosis, and pain
The Rollins Acquired Brain Injury Program includes the Disorders of Consciousness Program, inpatient rehabilitation, intensive outpatient rehabilitation programs, and post-discharge transition support. Rehabilitation programs are personalized to meet each patient’s needs and goals.” – Shepherd Center
One denial letter labels Peyton as a “Rancho Level 3 but medically stable” and refers to PSA benefit descriptions, which WYFF News 4 paraphrased: “The fact that a ‘physician has recommended, ordered or approved a facility does not, in itself, make the utilization medically necessary.'”
Injury lawyer Chris Pracht said this is included in the fine print of several cases he represents
“Who is in a better position to say what is or is not medically necessary than the treating physician? So many people fall through the cracks, and they’re never heard of, and they just accept this. It’s not medically necessary or sorry, that’s not covered.” Pracht said
According to the International Brain Injury Association, one million Americans are treated and released from hospitalization for traumatic brain injury every year. 230,000 survive, 80,000 inherit a related disability and 50,000 die
The Alvarez family is seeking plans where they can pay out-of-pocket
“This is the rest of his life. And it’s not. It’s not right. They should not be able to make that kind of decision. All of his friends would describe him as a fighter. One of the most stubborn people they’ve ever met. I can’t stop fighting for my son,” Trina said
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