Mom, Dad and Kathlin were informed today that the insurance company wants Kevin out of the hospital next Wednesday. The numeric system of achievement that the hospital and insurance company has set up is a way to quantify patients’ progress. According to that system, Kevin does not show significant improvement. To the hospital and insurance company, it does not matter that qualitatively, Kevin IS improving. The problem is that his improvement is too slow to be represented by this numeric system. Therefore, in the eyes of the insurance company, if Kevin is not “improving,” they don’t want to pay to keep him in the rehab unit.
We are incredibly frustrated and upset by this news. Kevin is slowly improving, especially on things that he desperately wants to get better at, like eating. We are infuriated that the system is this exclusive, that improvements like the ones Kevin’s been making do not count in the books as improvements. Therefore, the system ends up sending home those who are the most sick and need the rehab most, and it keeps the ones who are less sick and can complete the required steps most quickly.
It might be obvious by this point in my post that we want Kevin to remain in a rehab unit. He needs the 3+ hours of intensive therapy every day in order to keep these small improvements coming. We don’t want any company or hospital telling Kevin that he can’t be in a rehab unit because he’s not improving and that all his hard work has been for nothing—a) because we don’t want his spirits crushed, and b) because it’s simply not true.
We have been told that all we can do is call the customer service number on the back of our insurance card to file an appeal. However, they are planning to have Kevin out of Valley next Wednesday, and it would take much longer than a week to successfully argue for an appeal through that route.
I guess downer blog posts come with the territory once in a while. This is the battle we’ll be fighting during the next week. I’ll post updates if any new development occurs.
Kevin in the tube
Santa Cruz Chocolate Milkshake Rankings
- 1. Marianne's Ice Cream (Mexican Chocolate shake)
- 2. Marianne's Ice Cream (Chocolate Brownie shake)
- 3. Cold Stone (Dark chocolate ice cream, normal chocolate ice cream, and brownies)
- Marianne's Ice Cream (Chocolate Chocolate-chip Swirl)
- 4. Saturn Cafe (Chocolate ice cream and peanut butter)
- 5. Jack's Burgers
- 6. Betty's Burgers
- 7. Carpo's
- 8. Burger King
- 8. Sno-White Drive In
- 10. Chill Out Cafe (Chocolate, banana and peanut butter—I guess too many flavors for Kevin's taste!)
Shake Stars
- ★★★★1/2 Butterscotch Swirl from Marianne's
- ★★★★1/2 Butter Pecan from Marianne's
- ★★★★☆ Bananas Foster Shake (homemade)
- ★★★★☆ Oatmeal Raisin Cookie Dough Shake from Marianne's
- ★★★★☆ 3AM Truffle from Marrianne's
Palo Alto Chocolate Milkshake Rankings
- 1. "Old Fashioned" Chocolate Shake from Peninsula Creamery
- 2. Chocolate Shake from Häagen-Dazs
- 3. Chocolate Shake from In-N-Out
- 3. Chocolate Shake from Jeffrey's Hamburgers
- 3. Chocolate Shake from Rick's Rather Rich
- 4. Chocolate Shake from Palo Alto Creamery
3 comments:
As an future OT that has worked in an inpatient rehab facility...I know ALL about FIM (Functional Independence Measure) scores, which is how therapist document progress in self-care activities, or eating, or ambulating. The FIM scores is the basis of what the insurance companies deem is a patient's progress in therapy that is a) reimbursable and b) if a patient is making any progress. (I am pretty sure Santa Clara is using FIMs).
Now, my suggestion to the family and to the therapy team is to make sure that the therapists and doctors are actually documenting that "progress is being made within the FIM". What that means is that progress is slow (and especially considering his current condition), and may even fluctuate between good days and bad. Nonetheless...progress is being made.
It is up to the entire interdisciplinary team, but most importantly, to the case manager to understand the progress that is being made.
I hope this helps and if you have any other questions, please feel free to contact me :-)
Best,
Dre
I am so upset for you all. I am praying that 'Dre's' advice helps you in this new fight.
It is so incredibly maddening to know that the insurance company has so much power. Do not give up. I know my sister had to fight the insurance company regularly for her son's continued speech therapy and physical therapy and she has succeeded. We keep you in our thoughts.
Sincerely Toni and Steve Runyon
We faced huge hospital costs with our son. Fight it and document everything!
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