Missouri Attorney General's Office
Supreme Court Building…read more207 W. High St.
P.O. Box 899
Jefferson City, MO 65102
573-751-3321
To Whom It May Concern,
I am writing to file a formal complaint regarding a deeply troubling experience I had with Mercy Hospital and Dr. Cameron Hess, a pain management specialist at the Mercy Pain Clinic located at 2230 S. Glenstone Avenue.
This complaint concerns what I believe to be deceptive and obstructive practices that have resulted in a denial of medical care for my chronic and debilitating back pain.
Several years ago, I sustained a catastrophic, career-ending injury in law enforcement that required an L4/L5 spinal fusion and, more recently, the implantation of a spinal cord stimulator. Despite these interventions, I continue to experience severe pain. As part of my ongoing treatment, I sought a radiofrequency nerve ablation procedure through Dr. Hess.
On March 6th, I underwent an initial diagnostic injection to test for pain relief. Following the five-minute procedure, I was moved to a recovery room where nursing staff informed me that I would need to report an immediate 80% reduction in pain to be eligible for a second diagnostic injection--an alleged requirement of my insurance provider, Anthem Blue Cross. I informed the staff that I did not experience an 80% reduction but requested to consult with Dr. Hess. I was told he was unavailable, as he had already moved on to another procedure.
When I asked if I could activate my spinal cord stimulator to assess combined relief, I was again told "no" because I did not verbally state that I had experienced 80% relief. The staff was dismissive and unprofessional, insisting that Anthem Blue Cross required this arbitrary 80% threshold. As a result, my second diagnostic injection, scheduled for March 20th, was canceled.
Concerned, I contacted my Anthem/Blue Cross representative, Alicia, who informed me that no such 80% threshold exists in relation to CPT code #64493 or in any related policy that would restrict further authorizations.
On March 24th, I contacted Mercy Hospital's Patient Relations and spoke with an employee named "Camry." I detailed my concerns and requested information regarding the grievance process. Her response was dismissive and unhelpful. Although she claimed she would file a grievance on my behalf, she refused to provide confirmation via email or patient portal. When I asked multiple times to speak with a supervisor, she denied all requests and ultimately disconnected the call. The call ended abruptly at 10:53 AM.
On April 14th at 9:00 AM, I received a call from "Dillon" at 417-820-9774, who identified himself as the Practicing Manager for Mercy Hospital. He asserted that the 80% threshold policy was dictated by Anthem/Blue Cross and promised to email me documentation to that effect.
However, during a follow-up call on April 21st at 11:30 AM, he informed me that, upon consulting with their legal department, he could not provide any documentation and refused to answer further questions. I have left messages with their legal division and nobody from that office has reached back out to me with any answers.
As of today, I have received no such documentation, and I feel I am being deliberately stonewalled. According to Alicia from Anthem/Blue Cross, the claim made by Mercy that such a policy exists is completely false. In her words, "They FLAT OUT lied to you."
This entire ordeal has left me without access to a potentially helpful medical procedure due to what appears to be a manufactured policy, one that my insurance provider unequivocally denies. It is unconscionable for a healthcare provider to deny a patient pain relief based on arbitrary, non-existent standards--particularly when doing so results in prolonged suffering.
I am formally requesting that the Attorney General's Office investigate the policies and actions of Mercy Hospital and Dr. Hess. Specifically, I am asking for:
1. A full review of the criteria Mercy used to deny further treatment.
2. A comparison of Mercy's policies with the actual documented requirements from Anthem/Blue Cross.
3. An investigation into whether deceptive or obstructive practices have been employed that violate patients' rights or healthcare regulations.
This experience has not only impacted my health, but also undermined my trust in the very system meant to support people in pain. I look forward to your assistance in holding Mercy Hospital accountable and ensuring that no other patient is subjected to such treatment.
Sincerely,
Kevin Mueller
Cc: Mercy Hospital Legal Services
