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I am mad as hell. And I’m going to take this entire post to complain.
If you’re a regular reader, you probably know that my dad fell and broke his hip in early February. From the hospital, he was admitted to an inpatient rehab facility. He was released from an inpatient rehab facility in mid-March, only to fall sick with pneumonia just ten days later, which nearly killed him. Unable to breathe on his own, he was on a ventilator for nine days until his lungs improved. Then just three days later, his condition deteriorated again, and had to be put back on a ventilator for another five days. The entire month of April is completely lost to my dad. He doesn’t remember any of it. And my dad’s mind is VERY sharp.
Okay, let’s back up a moment.
When he broke his hip, the doctors scared the bejeezus out of us with the statistics. One-third of patients who undergo hip surgery to repair or replace a broken hip will be dead within a year. ONE THIRD.
The doctors explained to us how to improve those odds.
GET UP AND MOVE! Seriously. Walking as soon as my dad was able. Exercise that hip. His in-patient rehab stay after breaking his was very beneficial from a physical and occupational therapy standpoint. He had made decent progress.
Now, let’s fast forward to the more recent issue of the pneumonia.
So, when my dad was bedridden for a month with pneumonia following that progress he made with his hip in rehab, my sister and I were worried that his hip might never heal properly or worse, that he would become part of that one-third statistic.
In late April, when my dad was released from the hospital after the pneumonia, he had to go back to inpatient rehab again. Not bearing any weight on your legs for a month when you’re 73 years old makes you pretty damn week. Oh, and when you just had a hip repair surgery a month before that, it seems to make things a lot worse.
My dad has been making strides in the inpatient rehab. But it has been a slow process. He is still terribly weak, unable to stand for more than 60 seconds. He is able to walk about 30 feet using a shuffling motion, but the physical therapists are working hard to improve his walking, so he can pick up his feet more and not run as high of a risk as tripping over your feet and falling. He’s also not able to do things like get out of bed on his own or go to the toilet unassisted.
Highmark Security Blue Ends my Dad’s Coverage (Again)
So imagine my surprise yesterday when his Medicare supplement (gap insurance), called Security Blue through Highmark Blue Cross Blue Shield, made the unilateral decision that my dad had had enough inpatient rehabilitation and would need to be out by Monday. Oh, you’re not able to care for yourself? Oh well! Oh, you want to appeal? Sure, we’ll give you 72 hours. Of course, it is the Friday before a long holiday weekend, so good luck with getting in touch with anybody!
The rehabilitation facility staff was great. They started faxing 127 pages of daily physical therapy reports to Highmark Security Blue, which clearly indicate that my dad is not strong enough to be on his own yet. I’m sure that’s exactly what the staff wanted to be doing at 4PM on a Friday, but they were also adamant that my dad was not ready to go home.
So, of course, this situation would be enough to make anybody mad, right? Well, to me, it makes me mad as hell, but at the same time, I am not surprised. At all.
Why? This is just another instance in a long line of Highmark Security Blue making decisions about my dad’s health care, with complete disregard to doctors’ and other experts’ guidance. You know, the people who TREAT HIM every day.
Pattern of Highmark Security Blue Ending Coverage too Soon (Timeline of Events)
So, let’s go back to late 2012, when I first truly started paying attention to my dad’s health care.
- My mom and dad were in a very serious car accident. My mom died on the scene, and my dad was airlifted to a trauma center. When it was time for my dad to be released, doctors said he’d need oxygen at home. My dad had fractured a few ribs, making it painful to breathe, and his oxygen levels would drop below normal sometimes because he wasn’t taking deep enough breaths. Well, guess what? Despite the doctor’s orders for oxygen, Highmark Security Blue said, no, we won’t cover oxygen. Broken ribs is not a medically allowable reason for oxygen at home.
- My dad was also prescribed six weeks of in-home physical and occupational therapy after the car accident. Highmark Security Blue decided that after about 2.5 weeks of physical therapy, that was enough for my dad, and they stopped covering it. Nevermind that my dad was still so weak and in pain from the car accident.
- So, needless to say, given how weak my dad was from the car accident, he fell down the steps in his home in early 2013, fracturing his shoulder and his pelvis. He needed surgery to repair his shoulder. I kid you not, the “This is not a bill” statement of benefits indicated that my dad’s surgery to repair his shoulder and about a 5 day hospital stay was $160,000. That’s ONE HUNDRED and SIXTY THOUSAND dollars. Funny, if Security Blue had allowed my dad to continue with another four weeks of physical therapy after the car accident, he probably wouldn’t have fallen down the steps. I’m not sure how much four extra weeks of in-home physical therapy would’ve cost, but something tells me that it wouldn’t come close to $160,000. I should point out that surgery was not needed on his pelvis. He was just not allowed to bear any weight on it for like a month while it healed on its own. He spent a month in inpatient rehab, but just a week or two after he was able to bear weight on his leg, once again, Security Blue decided that that meant my dad was well enough to go home.
- Fast forward to the end of 2013. My dad finally needed to get a knee replacement surgery he had been putting off for years. After the surgery, he was released to inpatient rehab. Within about two weeks, Security Blue made the decision that my dad had enough inpatient physical therapy and ended his the coverage. And what happens about four weeks later? My dad develops a blood clot at his knee surgical site, which ultimately was misdiagnosed as an infection, leading my dad’s leg to literally BURST OPEN at the knee scar. He needed emergency surgery to repair the knee, and the rupture also caused his muscle in his thigh (sorry, I don’t remember which muscle) to tear. Perhaps if he had been kept in an inpatient rehabilitation facility a bit longer after his knee replacement, doctors would have noticed sooner the signs of a blood clot. But nope, Security Blue had kicked him out of inpatient rehab, and they ultimately had to pay for another major surgery, as well as ANOTHER inpatient rehabilitation stay, since my dad was not able to bear any weight on his leg until the muscle healed. Within DAYS of him being allowed to bear weight on his leg, once again, Security Blue ended their coverage of his rehab stay and sent him on his own.
You get the idea, right? HOW IS IT NOT OCCURRING to Highmark Security Blue that perhaps they shouldn’t end the doctor and physical therapist-recommended treatment he needs? Maybe if his coverage hadn’t been cut off so soon after his hip surgery, maybe he wouldn’t have developed the pneumonia? And now that he’s BACK in rehab following the pneumonia, how is it not occurring to them that by kicking him out, when he is still weak, might result in another fall and subsequent hospital stay?*
You know, I have a coworker who has a very elderly mother (maybe 90+), and she was in a nursing home. My coworker and I were frequently sharing stories about how ineffective care is for the elderly because of insurance company shortfalls.
After one of the (several) times my dad was kicked out of inpatient rehab, I was telling my coworker how thankful I was that at least my sister lived close to my dad, and could keep an eye on him, and that my dad could even stay with my sister if necessary.**
So, I said to my coworker, “I mean, I wonder what happens for elderly people who get kicked out of these facilities and don’t have family and friends to take care of them?”
His response was short, matter-of-fact, and unemotional.
“Oh, they die.”
I was completely taken aback by that response. Not necessarily because I found it upsetting (although it certainly is) or was shocked by the lack of emotion in his response, but mainly because of how illuminating those words were.
It had never occurred to me before. People sometimes don’t get the care they need because insurance companies get to make medical decisions (not doctors). And those decisions can ultimately kill people.
I want to know how we have gotten to a point in the country when things like medical care for the elderly has become so … broken? I can’t even think of a word to describe it. Why can insurance companies make these decisions?
I don’t have any good solutions to these problems. But all I can say for now is that I dread the phone call that can come again saying that my dad has been injured from some other fall or injury. I’ve had those calls a bunch these past few years. They’re terrible. There’s really no other way to put it.
Hopefully Highmark will review their decision and not end my dad’s care so soon, so that I won’t have to get yet another one of those calls.
*I should also point out that my dad’s inpatient rehab stays have been by no means free. Medicare only covers days 1-20 in a facility in a given year. Beyond 21 days is $157/day. He has well exceeded 21 days given his hip surgery and pneumonia have both been in 2015. Gap insurance, such as his Medicare supplement, was supposed to help cover costs like that. But nope, I guess it doesn’t.
**Staying at my sister’s house is difficult for my dad because my her house has a lot of steps. Same with my house!
