We have quite an update for you!
To begin, for anyone interested in Corey’s documentary BRAIN CRUMBS, the Wilmington Riverfront IMAX theatre has given FarmCat Media one of their theaters for a private screening. This means tickets are NOT open to the general public and cannot be purchased at the door. If you can join us, you are invited to go to www.recoverythyme.com (Corey’s website). FarmCat Media will be submitting the film to several Independent Film Festivals as an educational film promoting awareness, education and an innovative approach for the recovery of Traumatic Brain Injury survivors.
RECOVERY THYME – In addition to the documentary invitations, we’ve added a SUBSCRIBE link. Our carepage family is very important to us. The carepages have been a great communication tool; however, many of you have reached out privately because of admin issues in receiving the notification alerts. For this reason, we began to cross post to my Facebook page. Not everyone uses Facebook and we want to continue to share Corey’s progress. Corey’s webpage is the perfect bridge and will be managed by FarmCat Media so if there are issues with notifications or postings, we can call and actually reach our administrator to help fix it! We hope you will subscribe to follow Corey’s continued recovery as we transition from carepages to her website.
Therapy – bad news with good news…advocacy wins again!
Corey’s team recently submitted for more sessions. She has completed 24 out of the annual 60 visits insurance provides for PT/OT. Despite the detailed notes documenting her progress from December 7th through March 2nd, the medical reviewer denied further coverage stating that the diagnosis of a ‘concussion’ approves episodic care not long-term rehab.
This is the first of many issues with a 3rd party provider. What is a 3rd party provider? Most insurance companies hire an outside company to review all claims and requests. There is a checklist for every diagnosis. Every patient is a number and often the checklist of symptoms vs. ‘typical’ plan of care for that diagnosis is often the “standard” that every case is measured against. The reviewer often misses and/or does not completely read the documentation provided about the individual past the checklist. This is what happened with our most recent submission and subsequent denial. What the 3rd party company depends upon is our acceptance of their decision. The general public often does not realize logistics involved with the submitted information or the protocol used during the decision process. Therefore, a denial is often accepted by the insured individual without question and the insurance company doesn’t have to fund the needed treatment.
Fortunately, we have learned the process and this is where the advocacy lesson begins for those that haven’t. It’s ok to ask why? What was the basis for the reviewer’s decision? In Corey’s case, yes; she sustained a concussion on November 15th…BUT…it was a concussion on top of a severe brain injury. The reviewer did not look at Corey’s history, just the diagnosis. IF the reviewer looked at Corey as an individual, the documentation submitted by the therapy team supported and proved the 24 sessions used over 12 weeks were needed to strengthen her swallowing so she no longer choked on liquids and solids causing aspiration. Her speech was affected as well as her limited memory. Cognitive and Speech exercises were required to recall what was just barely improving. Her PT took 12 weeks to re-establish the brain signal to the muscles so her knees didn’t buckle with every step and her balance was stabilized to take each step. Her OT strengthened her ability to lift the weight of her arm in order to begin to have range of motion and hand movement to open and grasp objects for daily function.
I’m happy to report that we expedited an appeal forcing a new reviewer to re-read the documentation. The new set of eyes approved 12 more sessions, giving Corey an additional 6 weeks to continue therapy. Every session is critical for us to help her regain her pre-fall level of daily function. We continue to fight, question and educate the “decision makers” holding them accountable to look at the individuals NOT the “standard” protocol.
Insurance is a “for-profit” NOT “for-patient” industry. Please don’t forget, we do not ask for grants for services from our insurance companies. We pay into ‘the insurance of knowing’ we can be cared for when we need it. This is the definition of Insurance. I’m not sure when or how this framework became diseased or how we can reframe it but this is why I will continue to advocate for Corey and others to find their voice, choose the most affective words and fight to be heard.
Corey is very excited to share her voice through her website. She is most excited about the ASK CHEF COREY link. Your questions will assist her with her cognitive therapy exercises. She looks forward to researching the answers for your requests regarding new recipes or culinary tips. So please subscribe as she begins to blog weekly. We hope you will stay in touch with Corey’s progress, xoxo