Reeve Foundation Paralysis Community

My husband is a para who needs rotator cuff surgery in his dominant arm.  Right now he is in a lot of pain.  We were told by the doctor that my husband is not to use/move his shoulder for 3 months following the surgery; which basically means he will be bed-ridden.  We are having trouble with our insurance approving the after care.  The insurance won't even consider his case until he actually has the surgery.  Meanwhile, the doctor was supposed to schedule the surgery 2 weeks ago and we still have not heard back from the doctor.  We believe it's because they are "running into walls" also.  Meanwhile we are frustrated and just want to move forward. 

Does anyone know of resources we can utilize?  We live in Ohio. 

Can you be more specific with your request for resources?  I can share my thoughts but I am not sure which direction to go. 

Our insurance more than likely won't cover a facility for skilled nursing care or home care.  They won't even considering hearing to approve or disallow, until the surgery has happened.  We are trying to find resources to help cover some costs. 

Wow, that seems ridiculous to me.  I can’t believe that they realistically expect your husband to stay in bed for 3 months.  Able body people have rotator cuff surgery all the time and aren’t expected to stay in bed.  Boy-staying in bed for 3 months can present a whole host of other problems like pressure sores and such for your husband. 

 

I fear you are probably correct in your assessment that his insurance isn’t going to pay for either home care or a skilled facility because they will deem his needs as custodial aids of daily living, and they never pay for that stuff.  But it seems like they should pay for the required equipment to help him through his recovery.  I know of several paras that had this type of surgery, and they didn’t have to stay in bed.  What they did have to do is rent power chairs, lifts, get hospital beds etc., whatever they needed in order to facilitate the recovery period.  Have you tried this tactic with your insurance company?  I know your husband won’t be able to use his manual chair or perform transfers but with a power chair and a lift perhaps he would be able to be out of bed.  Most insurance companies will pay to rent certain prescribed equipment during a convalescent period.

 

You guys are in a tough position.  It is difficult to plan when you don’t even know what you are planning for.  I don’t know of any resources other than your insurance that will help cover the costs.  If you can push really hard for some needed equipment perhaps family and friends can help out during the most critical time right after surgery.

 

I say all of this knowing that it will be difficult.  My husband is a C3-C4 quad.  We have all of this equipment, and he needs this kind of care daily.  I know it is hard to find help but maybe since it is only short term people might step up.  I guess another alternative is to hire an aid for a few hours a day during the initial phase of his recovery.  Maybe others will have some ideas.  Good luck and let us know what happens.

 

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Trish

"Life isn't about waiting for the storm to pass...it's learning to dance in the rain."

A few thoughts:

Start here:

http://www.211ohio.net/

First Call 2-1-1: Ohio

Phone: 211

Provides callers with information about and referrals to human services for every day needs and in times of crisis.  Can offer access to the following types of services:  adult day care, respite care, home health care, transportation, support groups, Medicaid/Medicare, etc.  The caller is provided with phone numbers, programs and services provided, location, hours of operation, and any other relevant information for the inquiry.  All calls are confidential.

 

Also -as was mentioned above, you might be able to use technology/aids rather than a skilled nursing facility.  Try this site for loans, and used assistive technology that you might temporarily need:  http://www.atohio.org

 

An independent living resouce center in your state might also be able to lend some insights -try this link http://www.ilru.org/html/publications/directory/CILs.html

 

If you want to address with insurance appeals here is a guide:  http://www.kff.org/consumerguide/7350.cfm  If you do not have private insurance, let me know and I can suggest some other sites. 

 

My husband has the distinction of being the "first para" that our surgeon has every performed this type of surgery on.   So I believe the doctor is being overly cautious.  Thank you for the kind comments and thoughts.  My husband is very anxious and hopefully he will have this surgery soon and then we will go from there and do the best that we can with is care.   We are looking into electric wheelchairs which is a big step for my husband to make.

Thank you for the great suggestions!