I’m beginning to think that we need to start our own Reality TV show…the problem is no one would believe it was reality! Truthfully I can’t make this stuff up!!
After waiting an hour/half, the appeal was cancelled because the paperwork that our case manager sent yesterday did not get to the committee for today’s appeal. So now we have to resend the paperwork and ask for an additional 7 hours of skilled nursing. Depending on when the paperwork is sent, the Medicaid committee will have 48 hours to approve or deny the additional hours. Dr. Long did say that he would write for whatever hours we needed.
Now for the reality news…there was a letter waiting for me on Corey’s over bed table. It stated that “effective 12 noon on May 26th (yes, that is today) our attending physician has been advised and has concurred that further inpatient rehabilitation services are medically unnecessary (or) could be furnished safely in another setting. This determination was based upon our understanding and interpretation of available insurance coverage policies and guidelines”. “You are financially liable for all costs for the care your daughter receives, beginning on May 26, 2011 at 12 noon. If your daughter leaves on May 26, 2011, you will not be liable for costs for care except for payment of deductible, coinsurance, or any convenience services or items normally not covered by your insurance. (isn’t that generous?) you should discuss other arrangements with your daughter’s attending physician for any further health care she may require”.
Ohhhhhh, we’ll be discussing my daughter’s care! Tomorrow the phone lines will be burning up. I will begin by asking how Bryn Mawr can strong arm their families in this way. Are we not worth more than their bottom line? How is it that they can not intervene to influence a weekends coverage to set up Home Care? They are aware of my appeals to Blue Cross and Keystone Mercy. They are aware of my selecting skilled nursing. They are aware that the agency cannot have skilled nurses ready to staff until Tuesday.
What happened to their mission statement; committed to providing the exceptional care that has been entrusted to us by patients and their families.
I’m guessing that the last line of the mission statement should be their first…Operating our business with sound business principles and values – in a cost effective manner.
The home care agencies are busy working on building a staff to begin on Tuesday. What happens between now and then, I don’t know. I have contacted media, congressmen, senators and a lawyer. I am sending notification and complaint to the Department of Health, PA Attorney General and the PA Insurance Commissioner. It will be a busy day.
On a much happier note…The real reason for this daily carepage, MISS COREY
I did not witness this but our roommates mother called me today while I was in Philly. She shared that Brian, Corey’s day nurse, gave Corey a water spritz bottle. He sat at his desk and Corey sat across from him in her chair. He would give her the “high sign” and she would spay whoever passed by! Evidently she had a blast and was smiling through out the spritz session. I guess she’s getting ready for the summer fun on the back deck!
Corey, we have so much to look forward to this summer. Lots of friends, family, the kids coming back to visit, hanging on the back deck, long walks, lots of hard work to continue the great strides your making, visits to the candy store and much much more. I can’t wait for Amelia to jump up on your lap and curl up. Roxie is going to be so jealous. We’re coming home honey…My happy dream come true xoxo