What happens when you’re a 99-year-old World War II vet, a retired union worker and teacher, a father, a grandfather, a beloved member of the community, a holder of two health-insurance policies, and you fall, breaking both arms?
You are thrown out on the street because your vitals are stable so your insurance won’t kick in.
Welcome to the world we have fallen into — one of the growing gaps in our health-care system. But also one that brings into question the role that health-care workers and hospitals play in the health-care coverage process.
Because my father-in-law, Brattleboro resident Eugene Lepkoff, had recently sold his home, he is able to, for the moment, pay his $415-a-day stay at Pine Heights Rehabilitation as he slowly learns to regain use of his arms to get out of bed, feed himself, dress, answer his phone, and balance himself on his walker.
He will most likely be there all summer, racking up at least $20,000 in medical bills.
“What would happen if we couldn’t pay this?” I asked Leona Emmanuel Thomas, the Pine Heights director of admissions and marketing, who checked us in on a Monday afternoon after his six-hour emergency-room stay.
“He would be sent home,” she replied.
I just looked at her.
It was obvious he could not care for himself. Who could with two broken arms?
* * *
My father-in-law, doped up on morphine, arrived at Pine Heights in an ambulance and on a stretcher, even though the facility is just across the street from Brattleboro Memorial Hospital, where he was transported after his fall.
He was in that bad shape: with a black eye, lacerated knee, and his arms in two slings. Because he could read the nurse’s name tag and tried to make light of his predicament, and because there was an open bed at Pine Heights, the hospital deemed him fit to advocate for himself and encouraged him to sign himself out of the emergency room.
So, highly medicated and traumatized from his fall, he did just that. I arrived at 4 p.m., just in time to witness the medics coming in to whisk him away from the hospital.
“Why can’t he stay here?” I asked the emergency room staff.
“We’re full,” they told me in unison.
“And there’s a bed at Pine Heights,” added the nurse closest to me. “Better take it before it’s gone.”
* * *
Since my visits to Pine Heights, I have witnessed many open beds on the outpatient rehab floor we are on. But at the time, the hospital response seemed reasonable enough. I was also familiar with Pine Heights and have had friends who worked there.
The trouble began when we were presented with the Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNFABN), advising us that Medicare will not pay for my father-in-law’s care because there was “no three-day inpatient qualifying hospital stay.”
Because Medicare would not cover this cost, neither would his secondary insurance, Empire Blue Cross.
We chose an option on the intake paperwork to accept the non-coverage terms but be able to appeal any decision made by Medicare.
Thus began a two-week ordeal of deciphering what happened during the six-hour emergency-room stay, where no family member was contacted nor present and a doped-up, traumatized elderly patient was coerced into signing himself out without full understanding of the insurance implications.
Now things were looking off.
* * *
We are in a new world of class-action lawsuits such as the 2017 Alexander v. Price class-action case in Connecticut for Medicare beneficiaries.
Like my father-in-law, these plaintiffs were denied coverage rights and have joined the ranks of more than a million elderly patients in similar situations.
They are left having to choose between spending thousands of dollars on nursing-home care or going without.
How is this a way to treat our elderly — the men and women who birthed and cared for us, who worked hard for this country, paid taxes, and now need help back?