July 15 - Sicko....
If any of you have seen the movie, Sicko, by Michael Moore, what happened in that movie happened to us today. Our social worker came in to inform us that some nameless, faceless medical administrator with our insurance company, who has never even seen Seth and knows nothing about The Plan, had made a determination that Seth was not ready yet for acute rehab and should stay at Kindred until he is weight bearing (at least three more weeks). This even though his neurologist, medical doctor and the admissions people at Craig Rehab have all determined that he is absolutely eligible for Craig Rehab. I would say based on his progress, Seth should have already been there starting his acute rehabilitation a week ago. I was simply speechless. He was supposed to move to Craig Rehab tomorrow. Our social worker told us that Dr. Silo (one of Seth's neurologists who works on a rotating basis evaluating patients at all the various hospitals) would be calling this insurance person to advocate that Seth is indeed ready. Although I have never met Dr. Silo, he holds a very precious package in his hands. I really hope that he advocates to get Seth to Craig Rehab this week. Shouldn't Seth's doctors ultimately be the final arbiter on what care he needs not the insurance company? I feel like this is a nightmare.
If Seth's neurologist is not successful in advocating for him, I may ask for you all's help in helping me advocate for Seth. I will go to every level of Blue Cross. I will call my senators and congressman. I will get with whomever regulates the insurance industry to file a grievance. I will absolutely do everything I can to NOT let this happen. Hopefully, it doesn't come to this and Dr. Silo can convince the insurance person that Seth needs to be in acute rehab at Craig this week as his doctors had planned.
I'm sorry that I don't have better news to report. Seth and I along with my mom and Judy (Seth's mom) were obviously very disappointed with this development. At the same time, we have become very determined as we continue our way through this playing field to ensure we get the appropriate and best care so that Seth gets better.
Just like the determination that Seth has on his face for today's picture of him kayaking on the Upper Animas near our home in Durango!
Jody
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Reader Comments (4)
You can count on me to raise a litte heck if he doesn't get in to Craig this week.
You are so right, this system is a nightmare. 'The system' almost kicked my Mother out of a rehab unit because she wasn't making enough progress. Medicare said she should be in a long term nursing home. It didn't matter that we were prepared to PRIVATE pay for her rehab stay, the rehab unit was going to kick her out because they had to follow 'the systems' rules.
Ugh. This is infuriating. Just let me know what I can say/do and I am behind you guys.
Love,
Ingrid
I'm an old friend of Seth (and his brother David) from Boulder - I've been reading along and pulling for him. I think my folks were down from Boulder to visit a little while ago. The progress so far sounds absolutely phenomenal - and knowing Seth, even that many years ago, I wouldn't have expected anything else.
I've had a little experience with insurance companies as an attorney, and I think you're on the right track. Persist. There's always someone else to talk to. Make it easier for them to do the right thing than to do what they want to do. If I can help, let me know.
Never give up. Never surrender. Never take "NO" for an answer (unless you're looking for a "No"...). Most of all, take no prisoners...!!! I'm always up for a good fight against the "Evil-Doers" in the "System". Just say the word and consider yourself backed up.
Only the strong survive,
Monique
Jody and Seth,
I wish you the very best of luck. Unfortunately, I deal with this crap every day. I am constantly told that despite the doctor's and my best wishes for the patient and recommendation for continued care, that nothing more can be done for a patient, or that I am not allowed to provide the care that is needed. I it is infuriating. SIKCO is dead-on and it is frightening.
I wish you the best of luck in fighting the system. It is a big, nasty dragon. Go as high up as you can and put up a stink. But, as far as legislatures go, with private insurance, I am not sure how much they can do.
Let me know if there is anything I can do to help. I am more than happy to help fight this stupid health care system that we have in America. I have a lot of bones to pick with them, and this just adds to it.
The very best of luck,
Ash