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Thread: New SCI -- help and advice appreciated

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  1. #1

    New SCI -- help and advice appreciated

    On Saturday my 17 year old cousin was a passenger in a severe car accident and her C6 and C7 vertebre were broken but the spinal cord is intact. She is paralyzed from the chest down, doctors are saying 99 percent chance she will never walk again. She is starting rehab next week, Spaulding Rehab in Boston. The rehab place says the average stay is 12 weeks, yet her family's medical insurance only covers 8 weeks.

    So many questions...

    1) What are the financial resources available to her family to help cover the additional rehab expenses (and many other expenses down the road)? I did some research and found that Medicare might cover more days in rehab? I'm not sure what steps her parents have to go through to get additional coverage? Also the community is coming together to donate money, what is the best way for them to receive it, in a disability trust?

    2) Anyone had any experiences with Spaulding rebahilitation in Boston?

    3) She was supposed to be applying to universities this week... supposing we can keep that on track and she is well enough to go, does anyone know financial resources that might help her attend?

    Any other notes or advice or information would be MOST appreciated... this is all very overwhelming to our family in every way possible. Thanks in advance.

  2. #2
    Senior Member
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    Hi, I can only answer a bit of your questions, but I can tell you that Spaulding Rehab is great. The entire 7th floor is a spinal cord injury unit, and they work as a team. That will include both medical services, physical therapy, occupational therapy, and lots more. The setting is very nice....on the Charles River that separates Boston and Cambridge, with a nice park and dock for outside visits when she is able.

  3. #3
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    The other thing I wanted to mention is Mass. Rehab. Commission if your cousin is a resident of Massachusetts. It is not unusual for them to help pay for some educational costs, driving lessons if possible, and other things that might help her have full life.

  4. #4
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    It is possible that her insurance will pay for more than 8 weeks. The hospital can appeal that, and ask for additional time. They need to show that the additional time is medically necessary, and that she is still making progress. I know when I was in rehab (Boston Medical Center) they had to ask for additional time 3 X, It was extended 2 weeks, then 1 week and 1 week again. The hospital took care of that, and I am sure personel at Spaulding handle that all the time as well. I had to do the same thing for outpatient therapy as well. I was allotted 30 visits per calendar year, and that was extended a month at a time, for the rest of the year. So be sure to ask about it. Hopefully her insurance is similar to mine.

    (btw, my stay was for for 12 weeks)

    re fundraising, i don;t know anything about this personally, but click here to check this thread for information.

    re college check this link for some schorarship information, and talk to the Social Worker at Spauldingabout Vocational Rehab. There is a lot of funding available for college.

    good luck, I wish your niece the best.
    Last edited by sjean423; 10-04-2007 at 12:15 AM.
    T7-8 since Feb 2005

  5. #5
    As far as I remember, Medicare does not go into effect till you are injured for 2 years. We got State Medicaid because we had no insurance which covered everything! but your cousin is so young , she would have a problem getting state help. It's way too soon to know what the outcome will be. Doctors should never say never! Cisco's spinal cord did not get injured and he is still in his chair 7 years later but he also started wiggling his toes after 5 years so everyone is different and never give up. No matter what happens life is still good for us paralyzed or not. We'll be praying for you and your family!

  6. #6
    Senior Member Broknwing's Avatar
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    One thing to keep in mind is that the auto insurance of the person who's car she was in, her own AND the person at fault COULD all be responsible for the medical bills(they'll probably all say the other is responsible)...You may be best working with her auto insurance company to get medical coverage taken care of, they'll go after the other companies...If her company defers to the other companies they'll get it covered quicker...All medical bills should be covered by auto insurance first before personal medical insurance as she was in an automobile accident...I don't know what your state's requirements are regarding carrying personal injury protection insurance...I know FL just changed the requirement last week...DEF work with the auto insurance coverage b/c they are the ones initially responsible for her bills as she was in the car...Her personal medical insurance should be secondary...
    'Chelle
    L-1 inc 11/24/03

    "My Give-a-Damn's Busted"......

  7. #7
    Welcome to our forums. Please ask any questions. We are here to help.

    Medicare will not be a factor for some time. She must be disabled 24 months before she is eligible. If the family is very poor (less than $2000 in assets plus one house and one car) they may be able to qualify for Medicaid. They need to go after the insurance of the driver, but be sure to NOT sign a lump sum settlement offer (frequently offered early) without the advice of an excellent personal injury attorney and a complete life care plan.

    It is critical that any fund raising be done properly so that the money raised is not counted as an asset for her or the family if Medicaid looks like it will be necessary. Check out the "sticky" topic at the top of this forum for an excellent resource in this area. Also, get advice from the staff at the rehab center before purchasing equipment or doing home remodeling. I have seen people waste a lot of money purchasing the wrong things.

    Appeal the insurance limit, but be prepared to fail. Most insurances in my area pay only 6-8 weeks for inpatient rehab for tetraplegia, and less than 3 weeks for paraplegia.

    Have you considered Shriner's Children's Hospital SCI Center in Boston instead? They have an excellent program as well.

    The rehab program should link her up with both her current school system's IEP application program (critical that she have this for the rest of this school year), and also get her linked up with the state Dept. of Voc Rehab. The latter may pay for some or all of college expenses (although generally only for in-state schools).

    If she has paralysis, her spinal cord is damaged, not intact. It is rare that the cord is cut, but it can be physiologically severed by bruising, swelling, crushing or loss of circulation, as well as the inflammation that occurs in the hours after injury. Did she get methylprednisilone immediately after the injury?

    (KLD)

  8. #8
    Senior Member Dave E's Avatar
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    Get To Be On A 1st Name Basis With The "case Coodinator" Or Family Councelor At The Hospital. They Can And Will Do Amazing Things For You, Including Going To Bat Far You And Fighting The Insurance Companies. I Was So Blessed By The Help I Got From These People At Craig Hosp. My Other Advise Is To Get A Good Personal Injury Atty. Get Referances And Interview Many. Your Insurance Company Will Only Do The Minimum And Try To Convince You They Are Doing Alll They Possibly Can. Most Of The Time This Is Just Plain B.s. Good Luck!
    Dave E. C6-7 Incomp. Quad 9-06

    "NEVER LOSE SIGHT OF YOUR DREAMS!"
    "THERE IS NOTHING BETTER FOR THE INSIDE OF A MAN / WOMAN THAN THE OUTSIDE OF A HORSE"

  9. #9

    thank you all

    Hi everyone,

    Thank you all, I can't tell you how comforting it is to get some good first-hand advice.

    A few more questions, if anyone knows the following:

    1) how do disability trusts work?

    2) Has anyone used the transplantfund.org website to raise money? How does it work? Is the money raised earmarked for the one individual or does it go into a "regional pool" that must be shared by

    3) We are from Vermont, so any special funds and grants should probably be available to people from there, but any resources like that Mass Rehab one would be much appreciated.

    I guess all my questions seem to be about money, but my aunt (Morgan's mom) is a nurse and knows more about the medical aspect than I do, so I guess I leave that side of it to her. But if there's anything else you want to advice medically-wise that we should look out for please do advice, every word you write is helpful and thanks so much.

  10. #10
    Do you mean a special needs trust? It varies by the state, but generally money that goes into this (if properly set up) is protected from use to calculate assets for eligibilty for programs like Medicaid or even Section 8 housing. The down side is that the money can only be used for purposes described in the trust that are directly related to disability and health care expenses, and often the permission of a trustee is required to withdraw funds. If you are considering this, it is critical that the trust be properly established through a good attorney.

    Money collected through the Transplant fund is segregated into an account only for the use of the person that the money was raised for. It is not shared with anyone else. They help with acounting procedures, and again, assure that the funds are not counted as income, which could be a disaster if the person is apply for need or income based programs such as Medicaid.

    Look into Shriner's in Boston. There is generally no cost to you, and their SCI program is excellent. She is young enough to qualify for rehab there.

    When she is in rehab, they should be helping with information about vocational rehabilitation. If her state of residence is in VT, then it would be through the state program there, not the one in MA.

    http://vocrehab.vermont.gov/

    (KLD)

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