Not Healing Fast Enough? Coverage Denied.

[peggysue2]

Anyone acquainted with traumatic brain injury (TBI) knows how slow the path is to healing. The brain is a remarkable organ and will do its best to self-heal, rerouting neural pathways that have been broken during a head injury. But that repair requires patience, care and outside facilitation/rehab for best results.

Which is why the story of Caleb Freeman from Oklahoma caught my eye. Caleb was brain injured in a car accident on December 19, 2017. Blue Cross/Blue Shield have decided he hasn’t progressed fast enough in his treatment and will be cutting coverage as of 12 February. That’s less than 2 months coverage. For a brain injury!

This is personal for me because my younger son suffered a TBI a number of years ago, He spent 2 weeks in intensive care, 1 week in a step down unit, 3 months in an in-house rehab and nearly 3 months as an outpatient, It took him a good 18 months beyond that to walk without a limp, for the range of motion in his shoulder to fully return and for his vocalization to return to normal.

Two months? My son had barely regained control of his bladder and bowels in that time, let alone regain mobility,

I don’t know what these insurance companies are up to but they should be publicly shamed. We had a recent OP on an ALS patient denied basic services (respirator) and a new medications on the market.

I think we need to start a Wall of Shame for these insurance companies, those reverting back to their old ways, where denial=death=profit.

Disgusting!

https://www.carbonated.tv/news/blue-crossblue-shield-wants-teen-with-brain-injury-to-leave-rehab

[MineralMan]

1. All too common.

[peggysue2]

3. True, MM

But they seem to be getting worse. I had to fight Blue Cross/Blue Shield to get our bills paid when my son was injured. But he was never threatened with getting kicked out of rehab after two measly months. Or denying a respirator to an ALS patient?

It's beyond the frigging pale.

[appalachiablue]

25. The brutal, greed driven health ins. system in the US has been

moving steadily worse in the last 15-20 years. It wasn't quite so bad with mom's care, 1998-2001.

Yes, insurers and Big Pharma are even more emboldened under this administration.

This barbaric, backward and profit-based US health system must be replaced with Medicare for all!

All the best to you and your brave son.

> ADY BARKAN, ALS patient just denied a respirator- wonderful courageous fighter and health care activist who's been speaking out in the media and working with groups to call out people's needs and reform. What a true hero and inspiration he is.

http://www.msnbc.com/msnbc/watch/health-care-activist-ady-barkan-slams-gop-after-house-approves-tax-bill-1119998531538

[BigmanPigman]

2. They have no shame so it wouldn't work on them.

The GOP is as bad as the insur companies. They are greedy sociopaths. They lack feeling for any human and only care about themselves and how they gain and be benefit regardless of what they have to do to others to maintain their own, selfish agenda.

Remember that smug, smirky, little Pharm Bro Martin Shkreli? That is the face of the Big Pharm, Health lobbyists, and GOP money grabbing enablers. THEY DO NOT CARE!

You won't find any philanthropists like Carnegie and Rockefeller among them. At the end of their lives they had a contest about who could give away the most money after years of ripping the poor and weak off.

[peggysue2]

4. Shkreli is a disgusting human being

I agree the GOP is nurturing this inhumane attitude, not to mention the level of cruelty the Trumpster and his crew are willing to dish out.

It continues to floor me. I do not understand how people can be so utterly heartless.

[Egnever]

18. Apparently he is a small fry

There's a series on Netflix called dirty money. Episode three is all about the drug business and more specifically a company called Valeant. They were doing are still doing? the same thing on a much grander scale.

[sarah FAILIN]

5. My company self insures

A friend's husband became paralyzed in a surgery that didn't go as hoped. While still in the hospital, the nurses didn't roll him and he developed bed sores on his heels and leg, then staph on his heels. Doctor wanted him on a suction pump and it helped but not fast enough. The insurance company took it away and he slowly had both legs amputated just below his groin trying to get ahead of the staph. It eventually got in his pelvis. I think he lived 3 years after the surgery. All for want of a suction machine.

[peggysue2]

8. Oh God

How horrible. And how shameful for an insurance company to cause such needless suffering, all in the name of the bottom line. For the want of a suction machine.

I remember being scorched at Blue Cross/Blue Shield for denying bills that were clearly within our coverage program and complaining to my husband about the number of hours I spent on the phone arguing the case, point by point, sending reams of documentation. Made me realize that patients without an advocate to fight for them are really at the mercy of companies that have no mercy. Only spreadsheets.

[Crash2Parties]

21. Early 2000's I worked for a company that fully self insured.

Because they were our insurers, managers had access to (some? many of? certain parts of?) our medical records. Anyone who was too expensive, well...let's just say they used to brag about how healthy their workforce was.

[Freddie]

27. Used to work for a hospital

That was self-insured. One of my co-worker's husband was on the list for a liver transplant. Blue Cross, the plan administrators (actually the hospital administration), kept denying the transplant and related procedures. She knew what was going on; the hospital (oh so compassionate! We care about our patients!) was trying to run out the clock hoping he'd die before he could get the transplant. He didn't and eventually got the transplant, I believe attorneys were involved.

[uponit7771]

6. I have a TBI, had seizures shortly after and spent over a year in ST and rehab ...

... is less traumatic than your son.

I pray his recover is full

[peggysue2]

10. Thanks for that!

My son did recover after a long haul. But as you know, you do not get away clean after a TBI; there are always after effects and collateral issues. He's functional but still has issues with concentration and memory. Also a sleeping disorder and a general weakness on his left side due to a post-injury stroke.

That being said, considering where he started after the accident, stroke and multiple infections he's done pretty damn well. In fact, he had a small 'Lucky" tatooed on his chest a couple of years ago. It's a chilling reminder.

As for me? I don't need a tattoo. That period is forever burned into my gray matter.

Good luck with your own recovery.

[uponit7771]

13. Thank you !! I have similar issues with working memory, focus and general weakness ...

... from hormone imbalance.

I too am thankful for having an understanding support system and people around who knew exactly what was happening.

I know in my heart your son one day will be giving the care he received, that's burned in my soul now.

[Vinca]

7. Big insurance is emboldened. They know nothing will happen to them under Trump.

[LuckyCharms]

9. +1 Just getting ready to type this.

"Emboldened" describes it perfectly. I have been bombarded with letters of denial over the past month. Some for relatively big things, and some for them wanting me to try a cheaper drug.

They have always done this, but the pace lately has gotten ridiculous.

[peggysue2]

12. I think you're right

I had my battles with the insurance companies but this atmosphere seems much worse than before. The Trumpster wallows in the cruelty he creates for others. Hardly a role model for businesses who profit from suffering.

Dispicable really

[Honeycombe8]

11. Blue Cross. People here didn't want to believe my report on Blue Cross...

when I tried to find doctors who would take the lousy HMO insurance (that cost about $1k a month, but I got the subsidy).

Blue Cross is scamming the system, IMO.

My latest with BC is that for the FREE PREVENTIVE exam we are all supposed to get once a year, BC refused to pay $63 of it. Which meant I had to pay it. So much for a FREE PREVENTIVE EXAM.

Blue Cross's position is: what are YOU going to do about it? WE are the ones in control. And they are. The insurance companies run the entire health care system.

[Bernardo de La Paz]

14. The true death panels are the for-profit insurance companies. . . . nt

[WillowTree]

29. The Blue Cross Blue Shield company mentioned in the OP is a not-for-profit company.

[Bernardo de La Paz]

30. Oh, sharp eye. Thanks for the correction. . . . nt

[dembotoz]

15. medicare too with rehab

gotta show rapid progress or pt is cut off

[pnwmom]

19. They tried to pull that on my mother a few years ago, saying no rehab after 20 days

because she wasn't improving. But that wasn't actually the law. The current law says that there are full benefits for 20 days and benefits with a co-pay for up to 100 days as long as the rehab is necessary to MAINTAIN or improve the patient's condition.

So I had a fax war with the nursing home in my mother's state, sending them copies of the actual law, till they broke down and acknowledged I was right.

It was to THEIR benefit to change their policy and FOLLOW THE DAMN LAW because Medicare pays a higher amount than Medicaid, so they should want patients to stay on Medicare as long as possible.

When my mother walked out of that nursing home, 80 days after entering, staff stood there and clapped for her.

(Unfortunately, the co-pay is quite a bit higher now than it was then. Everyone on Medicare should have a Medigap policy, which would take care of the copay.)

[peggysue2]

20. That's the truly horrible part . . .

because you cannot use a one-size-fits-all attitude for TBI. Or really any other injury. Every TBI is different and every patient is different. Younger patients generally heal more quickly but depending on the extent and location of the brain injury and the general health before injury, the time required for rehab rocks in all directions.

Early, aggressive rehab can make all the difference for brain-injured patients. The rule of thumb when my son was injured was whatever you get back in the first 6-9 months is what you'll be living with. You can make small, incremental progress after that but the really big leaps are made early on. Which makes early and steady physical therapy, occupational therapy, cognitive therapies, etc. so crucial.

To cut people off from that aid is to cut them off from a functional recovery. Which is cruel and heartless to the extreme.

[pnwmom]

16. Thanks for sharing this. It's hard to see how this follows the law on Essential Benefits. n/t

[elehhhhna]

24. It doesn't but there is no one who'll enforce the law. That's the problem .

Laws and regs are meaningless if not enforced.

[HopeAgain]

17. This is why we need universal healthcare.

The Insurance companies have a conflict of interest with the health of the insureds.

[Sophia4]

23. To be exact, we need single payer insurance.

Let's take care of ourselves as a society. Why have greedy for-profit insurance companies doling out money for our healthcare. Let's be our own boss. Let us hire the managers of our health insurance companies. They should answer to us, not the other way around.

[area51]

31. Damn Straight!

Our current system is draconian/dystopian. PNHP is one good place to start for info.

[elehhhhna]

22. bcbs ok also just cut rural ok hospital reimbursement rates by 30%. Yep.

Impossible to absorb. Literally impossible.

[appalachiablue]

26. Americans must continue to fight for single payer, universal

Medicare for All like CANADA and other advanced nations have had for decades!

TOMMY DOUGLAS, greatest Canadian and social democrat politician who established 'Medicare for All' in the early 1960s.

[WillowTree]

28. BCBS of Oklahoma is one of the not-for-profit Blues.