Guaranteed Healthcare

If you have a Mail Handlers health insurance benefit plan, then don't have a stroke. Mail Handlers, which insures some 4 million federal employees, federal retirees, and family members, may not cover the cost of your stroke rehabilitation. My Mom recently had a stroke -- a "brain attack" that occurs when a clot blocks a blood vessel and interrupts blood flow to an area of the brain -- and she lost the use of her right arm. Luckily, the stroke did not affect her right leg or her speech, but, at 84 years old, she could no longer perform tasks that healthy right-handed people take for granted.

Strokes are the third leading cause of death and the number one cause of adult disability in the United States. Right after Mom's stoke, Mail Handlers certified (approved) a 4-day stay at Adena Regional Medical Center in Chillicothe, Ohio. A certification letter from Mail Handlers stated that the certification was not a treatment decision and that "decisions regarding treatment are always between the patient and the physician." After Mom's stay at Adena, Mom's doctor ordered 24/7 rehabilitation, and this is where our troubles with Mail Handlers began. The discharge planner at Adena said that Mail Handlers would only cover rehabilitation at a hospital rehab unit. They would not approve rehab at convenient, local assisted living facilities, so Mom was transferred to Berger Hospital in Circleville, Ohio, which has an excellent rehab unit and a dedicated, caring staff of professionals, but is about 20 miles away. Mail Handlers certified Mom for a 7-day stay at Berger. At the end of the seven days, Mom was able to move her arm at the shoulder and wiggle her thumb. Her doctor at Berger spoke with a doctor at Mail Handlers and was told that because Mom could get dressed and walk with minimal, stand-by assistance, the company would no longer approve her for continued rehabilitation. She was supposed to be discharged immediately, but, after much pleading by her doctor, Mail Handlers agreed to extend the stay for three more days.

Her doctor and the nursing staff all feel that she needs at least two more weeks of rehabilitation because of her stroke-related cognitive impairment, which affects her judgment, her attention span, her memory retention, and her motor skills. For example, she could easily turn a burner on the stove and not realize that her right hand is on the burner. The doctor at Mail Handlers did not go to Circleville and examine Mom, but made a medical benefit determination over the phone and directly interfered with the doctor-patient relationship. Mom's cognitive impairment was not even considered by the Mail Handlers doctor, who presumably will make a nice bonus saving the company money by denying claims.

Berger Hospital will have to discharge Mom and a discharge planner explained that if I cannot prove that Mom receives 24/7 care after her discharge, then she will be discharged AMA (against medical advice) and the hospital would report me to adult protective services for neglect. Again, the staff at Berger has been wonderful, but I cannot say the same for Mail Handlers. Apparently, I have to provide care for Mom at my own expense or go to jail. So I brought Mom home and obtained 24/7 care. Mail Handlers has been certifying home nursing and occupational therapy for Mom, but the sessions are maybe once a week whereas the program at Berger Hospital had three hours of rehab daily. I called Mail Handlers and spoke to Mom's case worker. I asked to speak to the doctor who made the determination and was told that their doctors only speak to other doctors, not to patients or family members.

How can a physician, who presumably has a license to practice medicine and has taken an oath to "first do no harm" intentionally deny rehab services to an 84-year-old woman who cannot use her right arm and lacks the cognitive skills necessary to live independently? How can an insurance doctor practice medicine over the telephone and over-rule Mom's doctor regarding her care despite the company's claim not to do so? This is unconscionable. What does this say about the health care marketplace in the United States? This makes a great case for filmmaker Michael Moore's vision of universal health care outlined in his latest movie, "Sicko."