Tuesday Oct. 12, 2004
Crunch time!
The insurance denied the referral to Escondido Learning Services at the last
minute. I have made a 72 hour appeal of their decision and await an answer
on Wed pm. Gerry is set to be discharge from Ballard on Thursday. His nurses
report "he is climbing the walls." Gerry is becoming more agitated as the
days go on as he verbalizes his desire to go home. He is trying to break out and
I receive regular calls from him as to when I am coming to take him home?
Pray his stay will not be prolonged as this will not help him.
I have modified the request for Escondido Learning Services, and now seek
treatment for physical, speech (cognitive), occupational therapy and
nero-phsyc appointments only. These are all benefited services to which Gerry is
entitled. The HMO requires the services be done within the network.
(Learning Services is out of network.) However, the current discharge plan is not
acceptable in that the two facilities they recommend in their network, don't take
outpatients and don't deal with brain injury patients respectively. Pray
they will reconsider and make a referral for out-of-network services to provide
for a workable plan to meet Gerry's needs.
Praise God that Aetna's subrogation department verbally indicated they will
not pursue the monies I received on my own un-insured's auto policy which
leaves me some money in order to private pay for in-care treatment at
Learning Services. Continue to pray I will in fact receive this decision in writing
soon from their legal department so I can be certain I can utilize these monies.
My desire is to have Aetna pay for the therapies and I would pay for the day
and overnight care at Escondido. Gerry would stay Sunday pm until Thursday
for his treatment and then come home for the weekends. Hopefully this time
at home will motivate him.
Please continue with me before the throne! May God be Praised. Love, Lori
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