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Recent Accident to My Son

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  • #31
    Shepherd allows, "therapeutic weekend outings". There is a lot to do in the general vacinity most of it via power wheelchair. Shepherd also offers family outings equiped with a bus. Ask them, don't rush into a vehicle. He might end up in a manual chair and a van would be an overkill.

    Check out Wheelchair Getaways or ask Shepherd directly.
    Every day I wake up is a good one

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    • #32
      shepherd is a great rehab facility. im c-6-7. they took us camping for a weekend on a lake, went to see my very first baseball game in a power chair, no shoes and a neck collar. boy i was a pretty sight but i wasnt turnin down my only chance to see a Braves game, lol.

      good luck to you all.

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      • #33
        money ,coruption and discrimination rules in the land of freedom[usa]
        the doctors forget the hypocrate oath ,the politicians as well.is the same all over the planet.money ....money .?the end of humanity .
        may i have one dollar please?check the paper and the rest of it.

        Comment


        • #34
          I'm glad to hear your son is doing better. It sounds like your making headway in your decisions and that BC/BS has been very helpful. One thing to keep in mind is the number of days that is allowed by his insurance. Everyone's seems to be different. For example, policies have a defined number of days and the amount of therapies you receive in a day are sometimes set. My son has a limited number of days with as much therapy as he can handle in a day. You will need to know what the parameters are.

          It sounds like your son's policy is similar to my sons. I hope that your case manager continues to be helpful. I also had a contact at the insurance company for all of the bills. My sons injuries were extensive and required numerous surgeries and a boatload of tests and doctors. My contact for billing at BC/BS handled all of it. I know it's hard to believe, but, I have hardly had to spend any time on billing issues. There were plenty, and they were handled by the insurance company. I'm still pinching myself that this was the case.

          Did you check on transportation to Shepherd? Who knows, there might just be a policy that covers that as well. His Human Resource department would have that answer. One family member was allowed to travel with my son, so I flew with him. Longest flight of my life, but that's another story. I think his vitals were stronger on that flight than mine! It's nice to be able to smile about it now.

          It will get better. It's a very long road and we don't quite know where it will take us. As you have read here, there is so much promising research in this field. Hopefully, our sons will have an opportunity for further recovery utilizing the emerging therapies we read about. We need to get everyone who has suffered a SCI, back to doing all of the things they love to do. When your son is up to it, encourage him to check out this site.

          I wish him a remarkable recovery in Atlanta!
          "Our lives begin to end the day
          we become silent about things that matter."
          - Martin Luther King Jr

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          • #35
            Craig is one of the best hospitals in the United States. Healthsouth on Shea has a inpatient facility, but it's very small. You also have to share PT with the outpatient people. Plus, I personally don't think their PTs are that good, IMO.
            Kessler in NJ is also an excellent hospital, but that's about 2700 miles away from us. I am glad that you found a rehab for your son. I wish you both the best of luck.
            - Jessica

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            • #36
              We have run into a problem with my son's PPO insurance, Blue Shield of CA. I had been talking to the Blue Shield case worker since Tues 2/20 about sending Brian to Shepherd in Atlanta for rehab. Everything was set to transfer him on Monday. I was told all along that Brian could chose where he wanted rehab because he had a PPO policy and Shepherd was an in network hospital. Then on Friday 2/23 at 2:30 a new case worker at Blue Shield said that they would not authorize treatment at Shepherd. I appealed this decision with Blue Shield on Friday. Now, everything is on hold until Monday when we will start the fight to get this approved. Shepherd is part of the Blue Cross Blue Shield network. The Blue Shield case worker only said that their doctor would not authorize treatment at Shepherd because they have good physical therapy centers in California and Briain doesn't have to go to Atlanta. I have a copy of Brian's Blue Shield PPO Health Plan and I can't find anything that says he needs Blue Shield's approval for where he receives inpatient acute rehab. On Sat. I wrote a letter that detailed the benefits for sending Brian to Shepherd I'm going to ask the doctor treating Brian to present this to the Blue Sheild appeal board. I talked to the Shepherd people to get input to the letter so I'm hoping that I've built an accurate and compelling case. Do I need a lawyer to argue this issue with Blue Shield. I was on the telephone for three hours on Friday calling:
              Brian's Employer
              The insurance broker who sold the policy to Brian's employer
              Shepherd Center admissions people
              The hospital where Brian is at case worker (Barrow Institute)
              Blue Shield case workers who have or are handling Brian's claim

              Roger

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              • #37
                Good luck. Don't give up. Keep fighting. The insurance companies main goal is to save money...not to get your son the right care. Don't give in.

                (KLD)
                The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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                • #38
                  Where in CA do they recommend? There is not an equivalent facility in CA to my knowledge. Use Shepherds return to work stats, he will soon be back paying his own premium.

                  Does Brian have a unique need, ie age, he should be with peers, vent, TBI, incomplete where neurorecovery might be an asset? Look for an angel and have the doctor use that angel. If Shepherd currently has a number of 25-30 year olds with similar injuries, then Brian can use this to assist in peer support as well as batteling depression.

                  I attached a few resources on insurance appeals, hope it helps. Also, you do have the right to participate in the phne conference for the appeal.
                  Every day I wake up is a good one

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                  • #39
                    Shepherd Justification Letter

                    Cheesecake

                    Attached is the letter we've written to justify sending Brian to Shepherd. I would appreciate any comments.

                    Roger

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                    • #40
                      Cheesecake

                      The doctor at Blue Shield suggested Santa Clara or UCLA for rehab. Shepherd was our choice because of the reasons I gave in the attachment Shepherd Center Letter2.doc to my previous post.

                      Roger

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                      • #41
                        1. Santa Clara lost their model standing
                        2. UCLA is not CARF accredited


                        Keep pushing back at them, you will win as will your son.
                        Every day I wake up is a good one

                        Comment


                        • #42
                          Might I reccomend The Rehabilitation Institute Of Chicago.

                          Hell, they are the number rated spinal cord rehabilitation center in the nation for 16 years now.

                          I went there and it was excellent. I would check it out.

                          www.ric.org

                          Eddie

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                          • #43
                            Good letter

                            I thought he wrote a good letter. He used the statswell. Ask him to get stats for low rehospitilazations and secondary conditions. Shepherd can give thta to you. I am certain BC/BS steered you towards Shepherd because Craig asks for a guaranteed 90 days.

                            The doctor might want add things like, "In my medical opinion, etc. Also, there is a PVA handbook on SCI outcomes. Let me look and see what I can locate. If I find something, I can email it to you.

                            Is his employeer willing to take him back? Let them stress quality of rehab and desire to bring employee back. I have seen large companies threaten to pul from BC/BS because of one patient and rehab. It has worked.
                            Every day I wake up is a good one

                            Comment


                            • #44
                              Clinical Guidelines

                              Here are some clinical guidelines and outcomes from PVA, this is for the professional. Might want to use the info to battle the insurance company. They are free to download at pva.org
                              Every day I wake up is a good one

                              Comment


                              • #45
                                Cheesecake

                                Brian's employer wants him back. Blue Shield is not steering Brian toward Shepherd. We want to go to Shepherd but Blue Shield has denied authorization. The Blue Shield doctor on the review board wants Brian to go to Santa Clara or UCLA. We want him to go to Shepherd. Brian's Blue Shield insurance is a PPO plan. The first Blue Sheild case worker told us we could go to whatever rehab facility that we wanted. Now the second Blue Sheild case worker is saying that Blue Sheild has to give us authorization.

                                Roger

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