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Thread: Recent Accident to My Son

  1. #51
    Senior Member
    Join Date
    Feb 2007
    Location
    Phoenix AZ
    Posts
    634
    Cheesecake

    We received authoization to go to Shepherd Tues about 11:00 am. I think Blue Shield gave authorization for Shepherd but refused to pay any transportation expense. My wife and daughter and going with Brian Wed at 8:00 am. Blue Shield sent me a letter on why they refused the transportation expense. It wasn't much of an explanation.

    1. The principle reason for the denial is that you do not meet the Blue
    Shield criteria for approval
    2. The clinical rationale for the denial is that specifically: (1) there is no
    documentation leading to the conclusion that appropriate spinal rehab
    services cannot be provided by one of Blue Shield's affiliated in state
    network providers, and (2) once an approved CA facility is selected, a
    clinical assessment will be made by both the current hospital facility
    and the receiving facility to assist in Blue Shield's determination in the
    most appropriate mode of transportation.
    3. Because the information provided shows that you do not meet the
    necessary criteria for approval, we are unable to comply with this
    request.

    Like I said this explanation didn't really satisfy me. Brian's insurance is a PPO plan so I don't understand the requirement to go to an " in state network provider ". Shepherd is a Blue Shield network hospital and the Blue Shield Evidence of Coverage says:
    "Benefits are provided for (1) Medically Necessary ambulance services (surface or air) when used to transport a Person from place of illness or injury to the closest medical facility where appropriate treatment can be received, or (2) Medically Necessary ambulance transportation from one medical facility to another."

    We doing #2 transport from one medical facility to another. I appealed the Blue Shield decision and they rejected the appeal. I'll pursue this after we get Brian into rehab at the Shepherd Center.

    Roger

  2. #52
    Great news on Shepherd. Brian needed to be transported one way or another. They should at a minimum pay what it would have cost to transport him to CA.

    Get his employeer to help contest this, you most likely will win. BC/BS has a ranking for their facilities. If you can get the score for Shepherd vs CA, maybe you can make a case.

    For now, concentrate onyour trip south. Bring lots of comfy pull up pants for Brian. Hooded sweatshirts help as well, Zippered are easy on and off. Try to bring what you think he will need, save dollars where you can.

    You might want to create a CarePage to keep Brian, and friends connected. You can get a free site at http://www.paralysis.org. The link in on the lowe left hand column.

    I wish you and your family the best on your new journey. Keep us posted.

    Yeah, Atlanta.
    Every day I wake up is a good one

  3. #53

    Thumbs up

    I am so impressed with this site-- Care Cure-- The info and empathay is invaluable. We buy the insurance and expect it to work for us and then find we still have to fight tooth and nail for what we deserve. Thanks Cheesecake for your input in this case.

  4. #54
    Roger, Let us know when you arrive in the south. Rebajane, always happy to help. We can each learn from one another.
    Every day I wake up is a good one

  5. #55
    Senior Member
    Join Date
    Feb 2007
    Location
    Phoenix AZ
    Posts
    634
    Cheesecake

    I'm at the Shepherd Center with Brian, my wife and daughter. Brian starts therapy on Monday. I'm very hapy with our decision to bring Brian to the Shepherd Center. The people are wonderful and the facilities look very good, better than what I saw in Phoenix at St Joesph's. I go back to Phoenix Monday morning early.

    Roger

  6. #56
    Roger~
    Glad you made it there safely. Safe journey home to Phoenix. Shoot me a PM, there is a patient there that I know. The two guys would probably get along great.
    Every day I wake up is a good one

  7. #57
    Senior Member
    Join Date
    Feb 2007
    Location
    Phoenix AZ
    Posts
    634
    Brian asked me a question tonight, I'm at the Shepherd Center with him. He has not regained feeling in his fingers althought he had hoped that feeling in his fingers would return. Brian sustained a C6-C7 injury 4 weeks ago, can feeling in his fingers still return? Given more time.

    Thanks

    Roger

  8. #58
    Yes, it is possible. It is always hard to predict what will return.
    Sometimes there is post injury swelling that occurs and it takes a while for the nerves to the injured area and areas above it to calm down and repair themselves.
    Even though 6 months is quoted in most of the literature, changes might occur up to 2 years later, and sometimes longer.

    CWO

  9. #59
    Roger,
    Any particular reason you chose to go to Shepherd rather than Craig?

    Hope you are doing well.

  10. #60
    Senior Member
    Join Date
    Feb 2007
    Location
    Phoenix AZ
    Posts
    634
    Quote Originally Posted by wisci
    Roger,
    Any particular reason you chose to go to Shepherd rather than Craig?

    Hope you are doing well.
    Wisi

    A few things influences me. We were all set to go to Craig. I had a telephone call from a man who works at Johns Hopkins, Pat Rummerfield. Pat interviews spinal cord injuried patients. He said that he has talked to almost 400 patients and he has concluded that Shepherd is the best.

    The other thing that influence me was when I called the people at Shepherd if they were leaving work to go home they gave me their home telephone number and told me to call them at home. The people at Craig were not as generous with their time they told me call back the next day. This is a small thing but it was significant at the time.

    I was at the Shepherd Center with my son yesterday when he was doing rehab. Mr Shepherd was there and I talked to him for almost 20 minutes. He is one of the kindest men you will ever meet. I told him that our experiece at the Shepherd Center was that all of the staff was extemely caring and kind. I believe that Mr Shepherd sets the example for the entire staff.

    Roger

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