Blue Cross Blue Shield of Tennessee: allow my husband the appropriate care he needs.

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February 1,2017 my husband went into cardiac arrest after a month long stay in the hospital for pancreatitis. From his cardiac arrest, he obtained an anoxic brain injury. He has been in 6 different facilities, during this he has been under 3 different insurance plans due to my job. The most current is Blue Cross Blue Shield of Tennessee. It has been nothing but hassles since January 2018. He was at a facility that was appropriate for the level of care he needed as he has a stage 4 pressure sore and is unable to participate fully in any type of therapy. Most rehab facilities will not accept patients with an open wound or if they are not able to participate in 3 hours of therapy. At the most recent facility he was improving, although still unable to participate fully in therapy. On January 16, Blue Cross Blue Shield of Tennessee’s Medical director decided that he no longer qualified for the LTAC level of care and denied his extension at that facility. I’m doing that, it forced that facility to hastily find a new facility for him, and he has since been placed in a nursing home. They are unable to provide him the proper level of care he requires and has started to decline. 

Blue Cross Blue Shield has now denied his current facility because of his physical therapy notes, he is unable to participate and so they denied his extension here.

My husband is now in limbo, not appropriate for either location. So where does he belong then? Too good for the last place, but not good enough for his current place and so he regressed. He needs to be appropriately evaluated and allowed to go to the facility that will take care of him best. He needs iv antibiotics for his pressure sore, bed rails on his bed so he doesn’t fall out of bed and people that know how to deal with a brain injury patient. He’s only 38 years old and we are now a year and three months into this whole ordeal. 

Please! Someone at Bcbs Tennessee must have some compassion! They should not be basing their decision off of PT notes, they need the whole medical chart!

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