How to fight to continue insurance support

[praise21]

My mother had a massive stroke on Sept 4 and was hospitalized with heart complications until the end of Sept. She was left with no movement of her left arm or leg and unable to swallow or talk. We now have her in a skilled nursing facility and gets 2 hours of theropy 5 days a week. While we have been told that she is doing great and can now swallow, speak some words, stand with assistance putting weight on her right side between parallel bars, we have received awful news from her insurance company. With only a 24 hour notice the insurance company has decided she has not made sufficient progress in the 34 days at the facility. We are shocked and confused. How can the goals and developed by the rehab center not match those of the insurance company? What can we do? We are going to appeal this ruling but what type of argument is needed to win against the mighty giants of the insurance world. The case worker said the insurance company told them she cannot walk any further than she did 34 days ago. But she is still unable to use her left side, unless there is some medical break-throughs a person requires more than 1 functioning side to walk. They want to put her in a nursing home, this will destroy her. Any and all advise is welcomed

[Biag]

I feel for you.  My mother had a massive stroke at the age of 58 in May 2007.  She lost movement on her left side, and initially had a lot of trouble with speaking and eating.  Here I am 7 months later fighting the insurance company.  She spent 2 weeks in the ICU because she needed to have surgery.  She was admitted to a skilled nursing and rehabilitation center for 10 days, but then had to be re-admitted to the hospital for nearly another month due to infections and complications.  After her stay at the hospital, she was re-admitted back to the same skilled nursing center.  After fighting with the insurance company, they finally admitted her into an acute rehab facility.  We were so happy to see her there, and she started to make very minor strides.  Within one week, the insurance company said that she was not making enough progress and sent her back to another skilled nursing center.  They continued therapy with her there for about another month before the insurance company said that her continued therapy was not medically necessary and that she had reached her plateau.  She has had so many complications during this time that have prevented her from being able to participate in therapy to her fullest extent.  One of the worst problems was excruciating pain on her left side (even though it is paralyzed, this pain is common after a stroke...it results from contraction of the muscles and also nerve damage).   One specialist has really helped her tremendously with the pain, but not before the insurance company cut her off.  Her neurologist says that the pathways in her brain indicate that she should be able to move her left side again someday, but he also said that it likely will not happen without continued aggresive therapy.  The insurance company is not listening to this.  The insurance company denied my appeal.  I then filed a grievance and included all of this information from my mother's doctors, but they denied the grievance and said that I can not appeal any more.  So...my mother lays in a bed at age 58 with no physical therapy.  This is a crime.  I am not going to go away, I will continue to fight, but it might not get me anywhere.  These people are ruthless, and it's hard for me not to wish that they also someday experience the pain and suffering that my mom is dealing with every day.

[lahinva]

We had the same situation with my dad.  After about 4 weeks inthe SNF, they said he had reached his potential and the insurance coverage was stopped.  We continued to fight their decisions and after about 2 months of fighting, we were able to get him moved to an acute rehab facility where he did 4-5 hours of therapy each day.  He was there for 3 weeks, and then able to come home with some help.  Is there an acute rehab facility int he area that you could contact?  We were able to get someone from the facility to come and evaluate my dad.  They agreed that he would benefit from more therapy, so they helped us alot with our fight.  Just continue to fight and never give up.  My dad was 80 at the time of his stroke, so I think they just wanted us to put him in a nursing home and give up on him ever getting better.  My dad never acted 80 though, he was still painting and wallpapering up until his stroke.  He is now at home with my mom and a few aids taking care of him.  He still cannot walk, but can stand and transfer to the bathroom, bed, etc.  We still are fighting form more in home therapy...

Good luck...