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Paralysed teen faces huge medical bill after insurance firm stops payments (Bermuda)

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    Paralysed teen faces huge medical bill after insurance firm stops payments (Bermuda)

    Last modified: September 17. 2002 9:51AM
    Paralysed teen faces huge medical bill after insurance firm stops payments


    By Stephen Breen


    A Bermudian single mother is facing a medical bill of tens of thousands of dollars for her son in the United States after Argus Insurance refused to pay for rehabilitation treatment which doctors say is essential.

    Ricky Carreiro, 17, may have to spend the rest of his life in a wheelchair after breaking his neck when he hit rocks while diving near Chaplin Bay in July.
    Under his mother Mary's insurance policy, Argus will only pay for one month's rehabilitation for Ricky at the Heathsouth Rehabilitation Hospital in Massachusetts, which ended on Saturday.

    Mrs. Carreiro is now facing bills of $1,500 a day because Argus will not extend the payments, despite a request from staff at the hospital to continue paying for least another month.

    Hospital staff say the extra month's rehabilitation will give Ricky a better chance of looking after himself in the future and could prevent him developing serious illness.

    Since Sunday, Mrs Carreiro has also had to start paying for hotel accommodation and does not know how she will afford the bills.

    She told The Royal Gazette last night: "I can't afford this as a single parent. Would the insurance people like this to happen to their son or grandson? Where's the mercy?

    "I don't understand how they can do it. This is not a backache. My son has broken his spinal chord and has no movement from the chest down.

    "He can't walk and we don't know if he will recover. The doctors say he needs to be in rehabilitation for at least another month.

    "I'm not trying to burn the insurance company, I'm just trying to get them to understand what I am going through.

    "I feel angry, betrayed, upset and hurt. I wouldn't want anyone to go through this."

    She said the hospital had been extremely understanding and had not asked for payment yet because it was hoping Argus would come up with the money.

    Nancy Richards, Ricky's nurse case manager at Heathsouth, confirmed yesterday that the CedarBridge Academy student needs more rehabilitation and failure to get the treatment could lessen his chances of becoming more independent.

    "He requires medical and rehabilitation services for another four weeks ideally," she told The Royal Gazette.

    "There are several long-range potential issues that could arise (if he doesn't get it) and I said that to the insurance company.

    "If a patient is brought to his fullest potential he has the potential to be independent, at a wheelchair level.

    "Without it, you run a risk. In Bermuda you don't have spinal care injury expertise. We know all the ramifications, and if a patient is short-changed, the chances are that they might cope fine, but if they were to develop say a bed sore or ulcer, it probably could be a huge surgical problem in the future and a chronic problem for the rest of his life.

    "This is very frustrating from our point of view. In the US, the normal rehabilitation period is 60 days and if the patient hasn't met their goal in 60 days, we request an extension of benefits, which is what we did for Ricky.

    "We usually get an extension of benefits. (The insurance company said) 'we've met our 31 day obligation and we're not going beyond that'.

    "It's really a shame. If it was my son and I was told that, I would be very upset."

    She said Ricky's family also needed more time to learn how to cope with looking after him in the years ahead.

    Argus chief executive Gerald Simons said yesterday: "We don't discuss individual cases, but the general rehabilitation is designed to cover short-term rehabilitation. That's what people pay for.

    "It was never intended to cover longer periods of rehabilitation for things such as stroke or spinal injury and there is clearly a gap in coverage in Bermuda.

    "I am not aware of any other local insurance company which provides long-term rehabilitation benefits.

    "For longer term care, family resources, Lady Cubitt Compassionate Association, the government and employers have been known to step in and cover this aspect of care.

    "Our role is to determine the benefits and pay according to the policy. The issue of what is an appropriate programme and those sorts of things, that's out of our hands.

    "Insurance policies are not unlimited. There are gaps in benefits available in Bermuda and its a community issue and it is the sort of issue that is best addressed in the long term by the proposed Health Authority."

    Anyone who can help the family should contact Ricky's uncle Mike Lema on 232 5276, or cell 237 5566.


    the bottom line to insurance this with CR's care


      I think

      I'm sure they have been advised to.
      1st contact the Department of insurance Local and nation there is a guarantee turn around time of 22 days which works for most people Insurance Companies are hated by courts and such, and most times will not go any farther, than this & its free.
      And I belive there is a law called"estopllee" I'm sure if I have the correct word I have it spelled wrong I'm sure this is the wrong word but the law reads EXAMPLE if a company accepts your payment late w/o cancelation and when you like 63 and sick and your late then cancels it is protedted by this law I will look look the correct word up asap.
      If they can find a case in which a person was accepted just one day longer than their so called time frame of recovery then they would have to allow them any amount of time.
      Most Hospitals have a rehab wing similar to a nursing home or perhaps go into a nursing home which offers this service its not a nursing home environment it is a hospital environment and it picks up the rehab process where the hospital left off and under the short tern care - long term care of their policy it would cover his needs in this area of the policy
      and if you think the Insurance Co. will tell them this they WILL NOT!!
      If he was in school or at a part time job he might have to his not knowing most companies offer this short term - long term coverage to their employees because it cost little its fully deductible and its a bait to get people to work for them, but most don't know this is offered to them because they don't listen, because they don't plan for being in this condition it always happens to someone else.
      and some home loans ? insurance policy could even offer to them a long term care coverage I have see this mainly on loans and most is for the Head of household and occ. for Household
      I I think of more cuz my sometimers kicks in mostly.
      I'm sure someone has advised them of all of this.
      this is what Insurance Advisers do and I'm sure someone has helped FREE.

      >They say it takes a minute to find a special person, an hour to appreciate
      >them, a day to love them, but then an entire life to forget them.


        It's Real, It Sux

        Welcome to the real world of SCI and insurance/medicare. Being in rehab myself, my insurance will pay for 60 "visits" annually not 60 days of rehab. A visit is one session with a PT or an OT, a visit to both PT and OT on the same day constitutes two visits, according to Blue Cross. However Blue Cross may pay for unlimisted home health care with includes PT and OT. Perhaps the lad's mom should look harder at the policy, there may be a remedy. I know Bermuda well and have a young nephew there who receives government help with his blindness. There are avenues to trod. However, it takes determination and thick skin to move forward. I hope Bermuda Mom pushes against the system and wins the battle.
        You C.A.N.
        Conquer Adversity Now