update on Tim

November 24, 2006 at 7:28 pm

To Jerimy, Shannon, Suzanne and others following this case. I talked today with Tim’s doctor at the nursing home and he gave a very thorough explanation of the the way the insurance company plays the game today for gbs patients and they aren’t the only ones. It seems that from day one of the crisis, the goal is to get the patient home as quickly as possible and only provide up to four weeks of acute rehabilitation at an appropriate stage that would maximize the benefits to the patient. This policy change came three or four years ago because the cost of acute rehab over a six to eight month period was very high, as much as $30K per week. So they put gbs in the same bin as spinal cord injuries and stoke patients and assume that once the initial medical crisis is over, they will plateau in terms of recovery and so for costs sake, the goal is get them home where basic custodial care is borne by the family and not the insurance company. In case of gbs or other similar nerve damage situations, if the patient recovers at home and can meet the criteria mentioned above for four weeks care, then they will admit them to an acute rehab hosipital for that period of four weeks.

I would appreciate it very much if anyone reading this knows anything about how the insurance companies operate in the this regard to give further evidence to what this doctor said, I would appreciate it very much. If this is the case and in Tim’s case this is clear, then I think we have to fight for better recognition of the gbs and the need to rehab as a MEDICALLY NECESSARY for recovery. Thanks, Richard