Posted on 08/30/2006 2:28:33 PM PDT by SoftballMominVA
Erin Monsell, a friend of my older daughter, was in a horrible car accident about a year ago. Her mom is asking for prayers and any type of assistance any of us can give. Erin is 18, a Christian and a very gentle girl. The family is stuck in a nightmarish position with insurance and therapy.
I have attached a copy of the email from her mom. The email will break your heart. It hits close to home to me because I remember Erin as a funny, laughing young lady who came to church with us and took my daughter to her church.
This is not a fake, urban legend email making the rounds designed to generate sympathy. It is unfortunately real.
In the email, the mom asks that this be distributed to anyone that could possibly help.
Please pray for Erin
I know this is long, but please find some time to read this. This is very important.
We just got word from Anthem that they have denied the coverage for Erin to be transferred to Kluge, or anywhere else for that reason. It went into appeal, a peer to peer review between the doctor at Kluge and Anthem's "doctor" (I have to put quotes there because I am beginning to believe that IF they are real doctors, they must be on the board at Anthem because they didn't know their stuff good enough to be real doctors). That appeal was denied. Their reason: It's been a "year out" from Erin's accident and there are not sufficient notes to indicate that she is worthy of rehab. Basically, there is no hope for her and they are not going to waste their money. They base this decision on notes that are, at best, three months old (some older), but then again, that's all they have because they denied recertification of Erin's therapy three months ago. So it's a catch 22: They don't have current therapy notes to go by, but they won't certify Erin for therapy to get current therapy notes. They've covered all of their bases so that they don't have to pay anyone anything from here on out (Medicaid is paying for Erin to stay at the Brian Center; they don't have to pay a dime for "custodial care" -- what Erin is classified (by them) as now -- Medicaid is paying the bill 100%. If Erin is elevated to "skilled nursing care" (in other words, she receives therapy) then they would have to pay for her care. The lady who came out and evaluated Erin on Friday is confident that they can have Erin out of their facility in 60 days -- if not going home, then to another facility for 30 days or less to "finish up" skills necessary for independent living. She could be out and home in 90 days, but because Anthem has denied all coverage, anywhere, Medicaid will not pay either. We are stuck, unless Anthem is convinced that they need to take care of their insureds. There are more appeals that we can go through with Anthem, but we've been all but told that it would mostly likely be for naught. The next appeal would be for the surgeon (huh? right?) to be appealed to for a peer to peer; that is 5 to 7 days out, or more. When that is denied, there is another appeal process for a rehab doctor to do a peer to peer, but that doctor has to take time from his schedule, travel from Richmond to little ol' Fincastle and evaluate Erin. How long do you think that would take?
Erin is doing way more than what she was doing three months ago (the therapy notes are over three months old). If she could be under an experienced doctor's care, in a rehab setting where she is monitored every day by the same doctor, and taken care of by his/her team of experienced, skilled therapists and nurses, they could address her spasticity (muscle tone) problems, and once that is under control, Erin could take off! She knows what she needs to do and she understands what is being asked of her -- she just can't control the muscle tone to accomplish the task. Kluge sees her potential and is irate at the decision of Anthem. Our hands are tied; our hearts are broken. Because of the decision of these uncaring people, who can actually go home and sleep at night after ruining lives around them, there is nowhere to put Erin, even the facility in Wisconsin (which, by the way, they denied them too), or the facility in New Kent, Virginia, or anywhere in the country. Kluge is going to try to pursue the idea of getting Medicaid to pay for it, but that effort is like trying to reach up and take a rainbow and drag it down to embrace it. If Anthem has denied a request, that's good enough for Medicaid (in most cases. There is that 5% chance).
If we were to pay for the rehab out of our pockets, it would cost more than $100,800.00 for 60 days, and Kluge wants all of it up front before they will transfer Erin for treatment. We don't have that kind of money, most certainly not in a few days. We feel that if we don't do something soon about getting Erin in rehab where she belongs, we will "loose" her. She lays in bed, dependent on some aid coming in every 2 or three hours and spending less than 5 minutes with her to change her and reposition her. Erin spends anywhere between 5 and 6 hours, on average, alone in her room, from the time I leave her at 9:00 in the morning, until Randy can get there most days at around 2 or 3 in the afternoon (he cannot go by every day for one reason or the other. On those days, Erin is alone for 9 hours until I can get there at 6:00 p.m.). She is so blue and depressed about spending countless hours in a nursing home. She was so depressed this morning that I couldn't get her to look at me. She would look when I asked her to, but then she would immediately turn her head towards the wall and stare at her pictures. I think that she is about ready to give up. She tried so hard during her evaluation yesterday; then we brought her back to the nursing home. She got depressed; maybe she thought that she "blew it" and that's why we brought her back. I tried to cheer her up this morning and told her that it was only for a couple of more days, that she would be transferred to Kluge this week and then she wouldn't have to come back. She smiled and signed "yes." She was ready. If I were to tell her now that we don't know when she will be going to Kluge, if ever, we fear she will shut down and give up completely. She hates it at the nursing home and wants out so badly. She wants a chance to go through rehab and go home.
Please pray. I don't even know where to begin to ask for what. I don't know what God's plan is; I don't know why we are going through this, in this particular path. I am physically, emotionally, and spiritually worn out. I'm beaten down in all areas and I find it hard to breathe some times. I continue to look to God for guidance and strength, but sometimes I wonder if I'm so worn out that I can't hear him or take notice of what he is working on. I know that we need prayer for strength, wisdom, discernment, guidance. I don't know where to go from here. Do we try to raise the money? How would we raise the money? Do we let Erin stay in the nursing home for months until we exhaust all of our appeals? Do we chance it and take her home, to a much happier environment? Do we have agency benefits out in the country where we live, or are we too far out to receive benefits? Will we have to sell our home and move to where we receive the benefits of at-home nursing care and therapies? I don't know; as I say, I'm tired. I ask God for guidance every day. If I ever needed an answer, it is now.
If you would like to write to your congressman (as we are going to do), log on to http://www.house.gov/ and enter your 4-digit zip code where indicated. To write Senator Allen, his web page is http://allen.senate.gov/public/. To write Governor Kaine, his web page is http://www.governor.virginia.gov/; select "Contact the Governor" on the left hand side of the page. The Virginia Bureau of Insurance email address is : bureauofinsurance@scc.virginia.gov. They will most likely tell you that all internal appeals have to be exhausted; we understand that. Except for that process takes months, precious months that we are wasting away for someone who needs and deserves care NOW, not 6 or more months from now.
Send this to everyone you think would help . The government needs to be made aware. Erin is not the only one that is going through, or has gone through, this. She will not be the last, but we can certainly make our government aware of how our insurance companies run our lives and make determinations that affect the rest of our lives, and don't give a human being a fighting chance to make a life of their own, even at the solid confidence of experienced, qualified therapists and doctors.
Prayers sent.
Blessings to Erin, her family, and friends.
I am so sorry for what this family is suffering. May God bless and comfort them.
Sounds like Erin could use some more visitors too!
http://www.roanoke.com/news/roanoke/wb/xp-36724
May God bestow great blessings on this family and may Erin's therapy start now and be a wonderful success.
Prayers for Erin and her family, and for a successful resolution.
Prayers sent for Erin, and for her parents.
Praying for this girl, her mom, whole family - In Virginia
Don't know who has VA ping, maybe Corin Stormhands?
Prayer PING
prayers sent
http://www.mainstreetnewspapers.com/articles/2004/10/07/fincastle/news/news05.txt
Prayer BUMP
Her stepfather, Randy Daniels, pastor of Mill Creek Baptist Church, assisted her at the car wash, as did friends Sarrah Sass, Emilie Iacovone, Jennifer Sass and Kaitlyn Meadows.
Looks like the other girl mentioned in the article I posted, who died in the car accident, was Erin's friend, Sarrah.
Prayers on the way for Erin and her family.
And, prayers for Erin and her family.
God be with them all.
Maybe, just maybe, there is something they can do to give this child some hope.
Prayers sent for Erin and her family.
Please post your replies to SoftballMominVA
SoftballMominVA, My prayers going up for Erin and her family. God's protection and healing for Erin God's comfort for the family.
Blessings,
trussell
If you want on/off my prayer ping list, please let me know. All requests happily honored.
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