Systemic Denial After Surgery: A Survivor’s Report of Sabotage by UnitedHealthcare

📅 Surgery Date: August 13, 2024

🏥 Facility: Denver Health

💰 Cost of Procedure: $46,686.94

🧾 Covered by Insurance: 100%

🔐 Insurer: UnitedHealthcare / Rocky Mountain Health Plans

🩺 Post-Surgical Hormone Crash: A Manufactured Emergency What should have been a period of rest and healing became a medical and psychological crisis—not because of my surgery, but because of what happened afterward.

After my gender-affirming bottom surgery, I requested a prescription change from oral estradiol to estradiol valerate injections—a safer option due to my history of blood clots around 2016. This was a medically supported choice made during my once-yearly appointment with my long-term OB/GYN (who has treated me since 2008). My provider wrote a brand-new prescription for injectable estrogen specifically to reduce clot risk post-operatively.

But UnitedHealthcare said no.

They denied the medication. They claimed it was “non-formulary.” They told my doctor I didn’t need it.

Let me be absolutely clear: this wasn’t about dosage. Estradiol vials have a hard 28-day discard rule after being punctured—something coded directly into the pharmacy packaging (see ⬇️). This was about power and ideology, not medicine.

💊 Hormone Crash: Physical and Psychological Breakdown When United denied my prescription, I was forced to ration old pills—cutting my dose to make them last. The crash was brutal: 😵‍💫 Extreme dissociation, mental fog

😢 Emotional collapse and intensified depression

🥵 Hot flashes, fatigue, night sweats

😡 Rage, irritability, panic

🧠 Cognitive shutdown—loss of focus, memory, and control

This wasn’t a minor inconvenience. It was a full-body, full-mind, full-spirit collapse—engineered by an insurance company that had no medical justification to interfere.

And I wasn’t the only one.

🧑‍⚕️ OB/GYN Resistance: Fighting Back Against Discrimination My OB/GYN did everything right. She submitted multiple prior authorizations—at least three. All denied. At one point, we spent over an hour on a joint conference call with UnitedHealthcare, trying to plead with them to follow the law. She pushed. She explained the blood clot history. She explained the discard window. She fought.

United refused.

Eventually, out of desperation, she sent in a script for oral estradiol again. United approved the pills. Not because they were safer. (They aren’t.) But because they could feign “compliance” while still denying what I truly needed.

Finally, on December 12, 2024—three full weeks later—they approved my injectable script.

📦 What Stockpiling Looks Like After Betrayal

What you see above is seven unopened vials of estradiol valerate. That’s 35mL—because I don’t trust them. Because I don’t feel safe. Because if United takes this away again, the consequences wouldn’t just be clinical. They’d be existential.

I am stockpiling my survival. Because I know what it feels like to be cut off. And because I know they’ll try again.

❌ This Was Not a Glitch. It Was a Political Attack. UnitedHealthcare didn’t just violate ethics. They violated the law.

Under C.R.S. § 10-16-104.3(3)(b), Colorado law prohibits health insurance carriers from denying coverage for gender-affirming care when such care is:

“Prescribed or recommended by a licensed health care provider and medically necessary to treat a condition related to the individual’s gender identity.”

The Plaintiff’s injectable estradiol valerate prescription—issued by a long-term OB/GYN provider following gender-affirming surgery—met every requirement under this law. There was no lawful basis for denial.

The Colorado Division of Insurance (DOI) has also issued formal guidance clarifying that:

Formulary exclusions may not be used to deny transition-related care, including hormone therapies.

📍 Legal citation: “Per DOI Bulletin B‑4.126 (2022), insurers may not exclude gender‑affirming hormones from formulary, nor may they deny coverage based solely on route or dosage. United’s denial of injectable estradiol violated both this guidance and state law.”

Insurers must provide equivalent alternatives if a specific formulation (e.g., injectable versus oral) is denied.

Dosage differences alone cannot be a valid basis for denial when a 28-day expiration cycle, not daily usage, determines refill needs.

🔬 Evidence: 28‑Day Limit on Multi‑Dose Injectable Vials Medical and regulatory authorities uniformly affirm that the expiration—or beyond-use date (BUD)—for opened multi-dose injectable vials is 28 days, unless explicitly extended by the manufacturer. This standard governs safety and refill necessity, regardless of dose frequency or remaining volume.

1. United States Pharmacopeia (USP) Chapter <797> According to USP <797>, the primary authority for sterile compounding:

“Chapter 797 of United States Pharmacopeia recommends up to 28 days as the beyond‑use date for opened or ‘entered’ (i.e., needle‑punctured) multi‑dose vials of sterile pharmaceutical injection containing antimicrobial preservatives.” — American Regent Estradiol Valerate Prescribing Information, citing USP <797> standards.

2. FDA Guidance The U.S. Food and Drug Administration reinforces this rule in its official labeling guidelines:

“The beyond‑use date … for an opened or entered … multiple‑dose container is 28 days, unless otherwise specified by the manufacturer.” — FDA: Labeling Guidelines for Injectable Products (21 CFR § 201.57)

3. CDC Injection Safety Protocols The Centers for Disease Control and Prevention (CDC) injection safety guidelines mirror this requirement:

“Multi-dose vials must be dated and discarded within 28 days after first use, unless the manufacturer specifies otherwise.” — CDC Safe Injection Practices Coalition

Want PROOF? CLICK!

📌 Legal Relevance: UnitedHealthcare’s refusal to refill estradiol valerate based on remaining volume ignores these mandatory safety protocols. The refill necessity is governed by expiration timing, not dose consumption. Once punctured, the vial becomes unsafe for use after 28 days—even if hormone remains.

Any denial that fails to acknowledge this standard violates basic medical safety and undermines state and federal gender-affirming care mandates, including Colorado’s statutory protections under C.R.S. § 10-16-104.3(3)(b).

UnitedHealthcare violated each of these principles. They denied coverage for a medically necessary, legally protected treatment—despite a valid prescription, a supportive provider, and a medical rationale rooted in blood clot risk and post-operative care. They forced the Plaintiff to ration medication, suffer physical and emotional harm, and eventually seek an alternate formulation—one that carried greater health risks.

This was not clinical decision-making. This was

Deliberate Sabotage.

And it was illegal.

These denials weren’t just “miscommunications.” They were targeted and systematic.

How do I know?

Because other trans friends in Colorado—different doctors, different prescriptions—had the same thing happen:

❌Denials of testosterone

❌Denials of estrogen

❌Denials of post-op appointments

❌Hours of appeals that led nowhere

❌Psychologically destabilizing delays

And all of this started in the weeks after my surgery.

🏛️ Coordinated Timeline of Political Retaliation Let’s match the timeline:

August 13, 2024: My bottom surgery is performed.

October 16, 2024: Donald Trump declares: “On the first day we will revoke Joe Biden’s cruel policies on transgender treatments… we will stop taxpayer funding for transgender procedures and drugs.”

December 12, 2024: Then-CEO of UnitedHealth Group Andrew Witty states: “We will continue to guard against unnecessary care.”

Those words are not coincidental. They reflect a coordinated political and corporate agenda. To label gender-affirming care as “unnecessary.” To withhold it. To eliminate access by weaponizing bureaucracy.

This wasn’t healthcare.

It was a purge.

It was administrative erasure in action.

⚖️ Intentional, Retaliatory, and Illegal UnitedHealthcare’s actions were not a mistake. They were a calculated breach of trust, law, and bodily autonomy. They used insurance denial as a method of elimination—of denying care, breaking spirits, destabilizing recoveries, and pushing trans people out of the system entirely.

And it worked—for a while.

But now I’m speaking.

This is not an isolated grievance. This is part of a pattern. It is deliberate, documented, and legally indefensible.

United broke the law. They knew what they were doing. And they did it anyway.

✊ You Don’t Get to Erase Me Quietly.

If you’re reading this, then the defendants didn’t settle.

They chose silence.

They chose denial.

They chose the gamble.

But here I am. 📢 Still talking. Still posting. Still surviving. And now, the world gets to see what they did.

#AdministrativeErasure

#HormoneJustice

#SurvivorNotSilenced

#UnitedHealthcare

#RockyMountainHealthPlans

🩸 “You don’t get to erase me quietly.”

Metadata Files Explained Short explainers unpacking how call logs, risk scores, algorithmic flags, and internal metadata were quietly used to profile—and ultimately erase—a human being from her own medical protections.

📞 How a Phone Call Became a Police File Your voice should never be a trigger for law enforcement. But in this case, it was. Routine member service calls—conversations that should have been protected by HIPAA and reviewed only by qualified personnel—were recorded, logged, and parsed for escalation risk. Instead of clinical staff evaluating emotional content or mental health nuance, non-clinical reviewers and possibly automated systems used call metadata to assess "threat posture." No psychologist ever intervened. No clinical review board made a decision. Instead, these calls became building blocks in a narrative of deviance, constructed not through diagnosis, but through data. The metadata associated with these calls—timestamps, call frequency, duration, internal routing notes, and escalation tags—was later included in a disclosure packet sent to law enforcement. Audio recordings were submitted weeks after the fact, stripped of real-time urgency. In effect, the calls were retroactively weaponized to justify law enforcement intervention where no emergency ever existed. The call was lawful. The message was emotional. The voice was distressed—but no more than any person under chronic, identity-linked medical harm. The choice to turn that into a police file was deliberate.

⚠️ "High Risk" Without Diagnosis In UnitedHealthcare’s internal systems—as with many large insurers—certain flags have outsized consequences. One of the most consequential is the label "High Risk." In theory, this designation is meant to help prioritize vulnerable patients. In practice, it is often used to mark those who disrupt workflows, challenge gatekeeping, or call too frequently. Here, the "High Risk" designation was not based on any formal psychiatric diagnosis. In fact, no treating mental health professional appears to have made such a judgment. Instead, behavioral notes, internal codes, and interaction frequency likely triggered the escalation. These flags can be assigned by call center workers, non-clinical staff, or through auto-generated risk scoring. The result: someone deemed administratively difficult becomes categorized as dangerous. Crucially, these labels are invisible to patients. There is no appeals process. No clinical review. Once marked, the member may find themselves excluded from protections—pushed out of therapeutic pathways and into the carceral ones. Law enforcement became the next contact point. Not care. Not support. Not help.

🧠 Emotional Flagging by Algorithm Call centers are increasingly driven by artificial intelligence. Sentiment analysis, emotion detection, voice stress scoring—these are sold as tools for quality assurance, but they can also serve as justification for escalation. If a voice wavers. If tone is misread. If volume increases, or cadence shifts. These patterns can be logged, tagged, and flagged. Systems trained on normative baselines are not trained for trauma survivors, neurodivergent speech, or the linguistic patterns of marginalized people. They are trained on patterns that reflect corporate expectations of docility. In this case, emotional distress linked to gender-affirming care was interpreted not as trauma, but as threat. Emotional expression became code for danger. It is likely that algorithmic filters or internal scorecards tagged the Plaintiff’s voice as unstable. These tags then moved her from support pathways into surveillance ones. The AI didn’t diagnose—but it criminalized.

🚫 When Metadata Becomes a Weapon HIPAA protects the content of communication. But metadata—the information about the communication—often slips through legal cracks. In this case, it was the metadata, not the clinical substance, that was used to build a false narrative of danger. Metadata includes: Call timestamps Duration Number of calls over a given period Departments contacted Keywords flagged in subject lines or routing notes Notes entered by non-clinical staff By aggregating this metadata, UnitedHealthcare or its agents constructed a timeline. But it wasn’t a care timeline—it was a pattern profile. These are the same tactics used in counterterrorism frameworks: frequency analysis, behavioral pattern detection, digital signals that predict escalation. And when these are interpreted without context—without understanding trans trauma, medical denial stress, or neurodivergent communication—metadata doesn’t protect. It punishes.

📬 What Was Sent, and When One of the most disturbing facts of this case is not just what was disclosed—but when. The PHI disclosure to law enforcement happened 35 days after the last known contact. There was no emergency. No live threat. No judicial order. And no immediate clinician concern. Yet audio recordings of legally protected calls were transmitted to police, alongside notes and attachments framed to cast the Plaintiff as unstable. This wasn’t crisis management. It was narrative management. The metadata—submission timestamps, envelope contents, routing emails—proves it. The delay alone negates any justification under HIPAA’s emergency exception (45 C.F.R. § 164.512(j)). That timing reveals intention. When care is needed, clinicians act immediately. When retaliation is intended, metadata shows the delay.

🧾 Internal Cover Letters and Submission Language Perhaps most chilling of all: the internal documents that accompanied the disclosure. These were not mere transmittals. They were framing tools. Staff wrote cover letters to accompany the PHI. These letters did not neutrally report facts. They selected, emphasized, and omitted. They cast the Plaintiff’s calls in a light of behavioral concern, cherry-picked moments of distress, and implied risk without stating it overtly. The metadata from these communications—the authorship, timestamps, intended recipients, and version history—can and should be analyzed in court. These are not neutral administrative notes. They are rhetorical acts of erasure—bureaucratic storytelling designed to turn a patient into a perceived threat. And once sent to police, they achieved exactly that.

🧠 What to Expect in Discovery Everything described above is discoverable. Dashboard audit trails Risk scoring algorithms Call tagging logic Staff training manuals Internal escalation pathways Version history on submission cover letters Email chains that discussed whether to refer Names of those who made the decision—and those who failed to stop it HIPAA protects against unjust disclosure. But when disclosure occurs anyway, the systems that enabled it become the subject of scrutiny. Discovery will not just reveal what was said. It will reveal how they decided who to silence—and what tools they used to make that decision. Metadata doesn’t lie. And now, it speaks.

There was a moment—one I can pinpoint with surgical clarity—where I realized they weren’t just trying to deny me care.

They were trying to disappear me!

The surveillance. The metadata. The disclosure. Not because I broke a law. Not because I posed a danger. But because I became inconvenient.

My name didn’t raise a red flag. My identity did.

UnitedHealthcare had no legal reason to send my personal medical information to police.

There was no warrant. No subpoena. No imminent danger. Just a phone call where I dared to assert my rights. Just a timeline that challenged their narrative. Just a trans woman on Medicaid who refused to be silent.

So they flipped the script. And they framed me.

Not as a person.

But as a potential threat.

And that is what happens when corporate systems are allowed to function like state intelligence. This wasn’t about safety. It was about containment. It was about eliminating the variables they couldn’t control.

It didn’t matter what I actually said. It didn’t matter that I followed the law. They labeled me unstable. Flagged me as risky. And then quietly delivered that label to the Grand Junction Police Department.

That is administrative erasure.

They didn’t kick down my door. They didn’t need to. Because when a bureaucratic label says "dangerous," you don’t need to be dangerous. You just need to be documented.

The day I felt so small was the day I felt like Luigi.

Not Mario. Not the hero. Not the face on the box.

Just the afterthought. The sidekick. The shadow.

That’s what it felt like when they erased me. When my voice was stripped of context. When my medical records were weaponized. When I was framed not as a person—but as a potential threat.

Luigi never asked to be second. He just wanted to exist. To matter. To be seen.

And that’s all I ever wanted, too.

So I built something they can’t erase.

AdministrativeErasure.org

If you want to see what they tried to bury, look here: https://www.administrativeerasure.org/2025/07/the-35-day-myth-of-imminent-threat

This isn’t a conspiracy theory. It’s a paper trail.

And it ends with a truth they can’t control.