Hi Everyone,

Corey’s entries are a significant sign of progress as well as being entertaining! Some of you have asked how she writes and how much of what she writes comes from her. Her entries are 100% Corey. We sit at the table, I read the entry from the evening before along with all your responses. She is usually inspired by something someone writes or she will ask me,
C-“what should I write”?
M-do you want to write about your day?
C-what did I do?
I repeat the days events. Corey quietly listens then begins to type on the computer
C-who am I writing again?
M-all the people that have been following your recovery.
She pauses and begins.

I honestly love watching her and reading as she types because I never know what she will write. She sometimes repeats the same sentence and I will the dublicates; that is the only time I touch the keyboard. Sometimes she will lose her train of thought. She asks me to reread what she has written then she leans in to continue writing. Her spelling has been 95% accurate with very little reliance on spell check. Her punctuation skills are off…she loves comma’s and exclamation points! I do not interject any verbal ques as she types but I will pose thought starters. I do help her separate her thoughts into paragraphs to help the fluency and remind her of the grammatical structure of writing.

What amazes me is the depth of her writing as well as her humor. She cannot always tell you what she is thinking but she can write paragraphs that are insightful one minute and make you laugh out loud the next. I truly believe her journaling has begun to help with her cognitive healing. Corey still has severe short term memory loss but when she is in the moment, she has great clarity, initiates conversation and interjects appropriate humor during our interactions. The down side; the second our conversation is complete, she has no comprehension of what we were discussing. The up side…she’s communicating!

I have appreciated Corey taking over the carepage the last few weeks. In between eating bon bon’s I have been fighting more appeals. In the last two weeks I have appealed the denial of coverage for 4 of Corey’s medications, continuation of nursing hours until she ages out at 21 and rehab coverage for PT/OT. It is my hope that sharing how we “cope” with our daily lives, our experience will help another person that may be facing their own personal challenge.

If you were unaware, a denial does not me NO. Every insurance company has an appeal process. There are typically 4 levels before your request is truly denied. Most people accept the initial denial, allowing the insurance company to make their profits. Very few take advantage of the tiered system not knowing that if you do, typically you will win the approval you’re seeking.

The progression of approval is not for the faint of heart. You must abide by the calendar restrictions for filing as well as the documentation requirements to support your claim. For instance, one of the medication denials we were challenging was for a drug called Provigil. Some drugs need reauthorization every 6 months. Despite the past approvals, she was denied coverage for this round.

This medication was originally created for shift work disorder, sleep apnea and pain associated with multiple sclorosis. There was a nation wide study funded by NIH (national institute of health – the mothership of medicine) showing that Provigil administered with Amantadine can “wake up” a Traumatic Brain Injury patient. In order to challenge the first three denials, I called NIH to get a copy of the study and submitted the documentation in level 4. In addition we were fortunate that Dr Long of Bryn Mawr hospital supported our challenge, calling the insurance company to educate the Medical Director on how the drug is used on the brain injury unit at Bryn Mawr. We were approved in level 4 with two days left before Corey ran out of her prescription renewal. I’m happy to say all Corey’s medications are now approved. This process took just under a month.

Rehab coverage is next on the list. Corey is making great gains physically; the down side to that is the insurance company is beginning to look at “how much more does she really need”? Once again we battle the difference of their goal vs. our goal (stability vs improved function) If a patient receives long term supported living services (generally 0-3 hours typical rehab post acute care) there is little recovery.

Long term care with intensive rehab has documented significant improvement on all measures; physical, cognitive, emotional and behavioral. Corey is the poster child for the findings of this approach. A report published in April of 2013 in the National Rehabiliation Journal shared statistical evidence that consistent Long Term Rehabilitation showed no regression in function. Statistics showed LTR increased steady gains across the board from Mild to Severe injuries. This report is helping our continued fight as we now submit functional improvement reports every 4 visits for PT/OT. I’m not happy with the limitations on the sessions but fortunately Corey does show something new each session.

Isn’t the saying “everything happens in 3’s”? Corey’s never followed the rules so why shouldn’t we expect our saying to be “everything happens in 4″s”
I guess I should be thankful it’s not trending towards my lucky number…7! xoxo