43 replies to this topic

[GottaHaveFaith]

I spoke with the admissions person at the rehab center at SCVMC in San Jose, CA.

She said since my brother was in acute rehab at the hospital our State insurance won't pay for a second rehab.

She said we should have transferred him to SCVMC after he got out of the ICU. I said we couldn't because we didn't have insurance at that point in time. We weren't able to get the insurance approved until after he was discharged from the acute rehab ward.

I think we should try anyway, and if we are denied ask for a hearing.

[Tetracyclone]

yes. ask for a hearing.

[quadinva]

I think its unwritten policy for the govt to deny first then grant appeals...Remember your screen name and listen to tetra

[GottaHaveFaith]

*wry grin*. I think you're right about that!

We're not giving up -- this is far too important!

[S&W Winger]

FIGHT! FIGHT! FIGHT!

The wheelchair supplier said no one ever gets the chair I have...Hill Rom said no one ever gets the bed I have...or the mattress i have...or, or, or...just remain steadfast!

And, you know you have all of us behind you!!

[S&W Winger]

Besides....it is NOT a second rehab...the initial rehab experience was an acute rehab, this is NOT acute...he needs an inpatient spinal cord injury rehab to learn the Life skills necessary as well as to progress as far as possible at this crucial time...later, he will also need ongoing therapy...but first things first: inpatient spinal cord injury rehab [vs. that acute rehab he received when initially injured]...

[S&W Winger]

Oh, and FAITH...! Please request that Simon rename this thread "I Think We Need a Bit More Luck" chance, coincidence, Fate, destiny, Karma, Kismet...anything but "Out of Luck," Hon! None of us got this far with a title like that!! Who are you and what have you done with Faith???

[GottaHaveFaith]

S&W Winger, on 03 March 2011 - 02:18 PM, said:

Besides....it is NOT a second rehab...the initial rehab experience was an acute rehab, this is NOT acute...he needs an inpatient spinal cord injury rehab to learn the Life skills necessary as well as to progress as far as possible at this crucial time...later, he will also need ongoing therapy...but first things first: inpatient spinal cord injury rehab [vs. that acute rehab he received when initially injured]...

You put this so well!

[Snakeye]

Keep asking, pleading, demanding cause the squeaky wheel gets the grease in most cases....

[GottaHaveFaith]

We have an ally at the hospital! The OT who lent my brother a powerchair while he was in the hospital the first time (which we still have because ours hasn't arrived yet) contacted a hospital case worker about my brother's situation... I'll keep you guys and gals updated.

[jscott92064]

Good luck!!! Keep up the fight! It's so hard at times, but totally worth it!

[GottaHaveFaith]

I'm keeping the title of this post, Bev. *grim look*

I just spoke with the hospital casworker who said that SCVMC turned down my brother after speakng to my brother's neuro doc. They said he doesn't need any more rehab.

Has the world gone mad?!

A different rehab facilty (one in San Francusco is sending someone over the hospital evaluate him tomorrow.

Oh, and his doctor plans on sending him home tomorrow! That had better be delayed (I phoned his hospital case walker and learned she is going to talk to his doctor).

Edited by GottaHaveFaith, 04 March 2011 - 03:40 AM.

[jenny407]

Faith, I'm sorry to hear of your problems.
In Germany, though, it seems to be similar: Often people who need rehab have to fight really hard for it - and sometimes, others are offered rehab who don't want it. It's a crazy world.

Be assertive, insist, exaggerate (if necessary), be loud - don't accept.
I do wish you luck!

Jenny

[hooplady]

Yuck, it makes me sick to hear this. My b/f had a similar experience - most of his time spent in rehab was useless. Because he had a pressure sore they never taught him to sit up or transfer in/out of bed. He used up his Medicaid inpatient days so they sent him home; he had to wait almost a year before he had earned any more days. Thus he ended up alone in an apartment where we thought he would be indpendent, but he wasn't for a very long time.

You just assume these things can't happen, yet they do every day.

Are they telling you he can never have more rehab, or he just has to wait? Keep fighting until you have exhausted all the options. Good luck, Faith!

[S&W Winger]

I'm staying positive, Faith...he needs a physiatrist overlooking his rehabilitation, not a neuro...ask that wonderful OT for the name of one, perhaps from that directory of providers you have...

[GottaHaveFaith]

Memorial Hospital acute rehab's physiatrist told SCVMC rehab that he doesn't need any further rehab because he's no worse off after Monday's neck surgery. And SCVMC agreed (without an eval visit) so we've crossed them off our list.

The visit from the San Francisco rehab staff person (they work with all different types of conditions -- not just SCI) was optimistic about him being accepted. And she was appalled that Memorial is denying more rehab.

And now we have a social worker going to bat for us (she contacted San Francisco).

For those who don't know my brother's progress, he can transfer from the bed to the powerchair (and vice versa) without assistance. He has not attempted to transfer to the floor. This is what we are hoping a rehab facility will teach him. We also hope that one day he will be able to cut up his own food and feed himself and hold a cup and drink from it while holding it. We want him to gain as much independence as possible. We know he isn't going to get everything back. But we believe that further rehab will help him gain back more of what he lost.

Edited by GottaHaveFaith, 05 March 2011 - 12:55 AM.

[Soryfam]

I'm glad you've got people working with you. He certainly has a good chance of having more improvement. Hope it all works out.

Sandy

[Tetracyclone]

I expect he can get those things back. i hope the rehab comes through, but in the meantime never think rehab is the only way to learn things. Many of us have figured out most off what we know after we got home. You just think hard and break an activity down into manageable bits, learning them one by one.

[S&W Winger]

Tetracyclone, on 05 March 2011 - 03:10 AM, said:

I expect he can get those things back. i hope the rehab comes through, but in the meantime never think rehab is the only way to learn things. Many of us have figured out most off what we know after we got home. You just think hard and break an activity down into manageable bits, learning them one by one.

Of course...but rehab sure does give one a nice tool box with which to work! And perhaps a trick or two up other sleeves...

The old necessity is the mother of invention should've had SCI tossed into that mix...then just imagine the amazing World...well damn if it already isn't!! and it just gets better from here on out...

[S&W Winger]

I am sorry I did not get your photo today, as it was an unusual rainy day, thus the ocean would not be its usual dazzling self...will see tomorrow...

[GottaHaveFaith]

Tetracyclone, on 05 March 2011 - 03:10 AM, said:

...but in the meantime never think rehab is the only way to learn things. Many of us have figured out most off what we know after we got home. You just think hard and break an activity down into manageable bits, learning them one by one.

We agree with you 100%!

Faith

S&W Winger, on 06 March 2011 - 12:49 AM, said:

I am sorry I did not get your photo today, as it was an unusual rainy day, thus the ocean would not be its usual dazzling self...will see tomorrow...

That's okay, Bev, I have lots of patience. Hmm, I think I'll upload a photo of an ocean creature to facebook for your viewing pleasure. Look for it later.

Cheers,

Faith (AKA Nikki)

[S&W Winger]

GottaHaveFaith, on 06 March 2011 - 02:56 PM, said:

That's okay, Bev, I have lots of patience. Hmm, I think I'll upload a photo of an ocean creature to facebook for your viewing pleasure. Look for it later.

Cheers,

Faith (AKA Nikki)

OK, woman of a thousand names...it was raining again today...thank you for the FB photo...causes me to want to drive the creature...still have my Class A CDL, so as long as it has hand controls...lol...it is a great pic! I did see those along the coast there...and all those dock dwellers also...I just Love when animals take back over...

How is your brother today?

[GottaHaveFaith]

His pain level is decreasing. A PT is having him sit in the tilt chair at least once a day.

[GottaHaveFaith]

I didn't't get to visit my brother last night because I had to work late.

I talked to my dad when I got home and he said they're discharging my brother today (Tuesday).

It is going to be harder on his daughter in regard to caregiving because he is still healing from his neck surgery.
But she's very happy that he's coming home.

[S&W Winger]

I still do not understand why he is not going to a SCI rehab???? His acute rehab was just that?

But OK, do you still have the PT & OT set up to come to the house?And could he get outpatient rehab at a facility?

[GottaHaveFaith]

Spoke too soon: I just called his daughter. He's still at the hospital. It is undecided as to whether he is going home today.

When he is home he has PT and OT that comes to the house.

Edited by GottaHaveFaith, 08 March 2011 - 05:54 PM.

[GottaHaveFaith]

Mixed news.

They're releasing Steve at 6:00 tonight.

The San Francisco rehab facility accepted my brother. Hurray!

State insurance denied it (we will appeal). Boo!

State Insurance told the social worker to contact a rehab facility in Davis.

Today is the last day my brother has the helpful social worker because he's being discharged. Boo!

[Soryfam]

Well, that is a mixed bunch of news. I'm so glad he is going to a rehab facility. I know California is in terrible shape with their economy, but it seems llike your appeal should be taken seriously. Kind of like social security disability--you just have to be persistant. I hope it all works out. Thanks for keeping us posted.

Sandy

[S&W Winger]

I have faith that he will get into the SCI rehab that he needs (SF would be great)...thank you for the update...let's all keep up the positive Energy....

[gsp23]

Jumping on this tread a little late but glad to hear he was accepted anyways. I had a similar situation. They discharged me from the hospital on a Friday (had already talked to the insurance company and everything before they told me). So that meant that I had to go directly into rehab on Saturday or they wouldnt pay. They wouldnt pay to stay in hospital over the weekend either so I got into rehab at that same hospital instead of one near my house like I had been planning on (I was over 4 hours away at the Mayo Clinic rehab). I didnt stay long there and insurance wouldnt pay if I transfered anywhere else, only outpatient which I ended up doing for a year. If I had known better and pushed for more in-patient I wouldnt have had such a long time in out-patient so its important to learn skills and work on function early on. Glad to see your brother has you to push for this.