I am so grateful to Fox News. The talent of our producer was evident in his ability to edit 9+ hours of footage to 3 minutes giving the audience a compelling story. We are hoping that Corey’s story will reach the media and political arena’s to be the catalyst of change for continued intensive rehabilitation that thousands of TBI patients deserve.
When we were in Bryn Mawr Corey was receiving 18 hours of therapy a week. When a patient is released from the acute care hospital setting to a sub acute or skilled nursing facility (nursing home) therapy hours diminish to 4-6 hours per week on average. This is standard and based on a national average of patients that improved as an inpatient in the acute care hospital.
What about the patients that don’t improve as quickly? What about the patients who have a severe injury that are compared to the mild or moderate injuries? They are sent to the step down or home care setting; frequently they are re-hospitalized due to the lack of clinical care and often regress due to the drop in therapy hours. Insurance Companies are deciding what is best for the patients based on their profit margins.
I went before the Appeal committee again this week. Dr. Long prescribed 3 hours per day of PT/OT/ST for 5 days over an 8 week period for Corey. Blue Cross only allows 30 hours of therapy (collectively) per calendar year. We exhausted those hours in the first month. When our primary insurance is exhausted, Medicaid then covers the hours. However, Medicaid’s Medical Director denied Dr. Longs request and approved 6 hours per week for 4 weeks. That’s based on the “national average” and they feel is “adequate to continue Corey’s progression in her recovery”. Corey has been receiving 6 hours of therapy/week since we’ve been home. She is NOT improving at the same rate as she did in Bryn Mawr. In fact, she has increased foot drop as a result of not receiving enough PT and she is having increased difficulty in swallowing and managing her saliva as a result of not having enough ST.
When I go to an appeal, I sit across from two medical directors, an appeals mediator and on speaker phone is a third medical director and Case manager. They give me 15 minutes to plead my case and present any evidence to support my argument. Once completed, the Medical Directors are free to ask me questions. Their decision is made by the end of that business day however; they do not call with their decision. The Appeals Board will send a formal letter by US Postal service which will arrive within 5 business days. In the meantime, Corey is without therapy until the decision letter arrives. If I disagree with the decision, I can enter a 2nd and 3rd level appeal. Once the 3rd appeal is heard, the decision is final. PS-the insurance companies make it a practice to say NO three times. Most families give up by then…NOT THIS FAMILY!
The direction of Healthcare is to shorten the length of stay in an acute facility. The direction is to move the patients care towards home and/or skilled nursing facilities. In our case, we are happy to have Corey home. Corey, like so many TBI survivors, are clinically stable and cannot remain as an inpatient in the acute care setting. The issue is they still require the acute intensive level of therapy but in the home or skilled facility setting. That concept is unheard of! This is why it is so important to write our Senators and Congressman. TBI patients must receive at least 12 full months of therapy to maximize the “window” of healing and regeneration of the brain. The 12 months we speak of is after the 6-12 weeks of healing from the bodily injuries the patients typically sustain. Unfortunately, the Insurance Companies start the clock at Day One. We need our Senators and Congressman to hear that this is unacceptable.
It is our goal to bring awareness to this issue. As I’ve said before, this is not just Corey’s fight. This is the fight of thousands of families that are denied coverage and are determined to help their loved ones regain the life they dreamed of. For the families that are doing the best they can to accept, cope and fight their way through the recovery process, “surviving” is more difficult than being told of the initial accident. If the broadcast can help one family, it will be worth it. Corey, you’re a Star! xoxo
This is an Article from FOXnews.com; http://www.foxnews.com/health/2011/07/18/brain-injury-injustice/