The Clarion-Ledger reported Madison Mayor Mary Hawkins-Butler and her husband Jim Butler won a victory against Blue Cross/Blue Shield before a federal arbitration panel recently:
"An administrative appeal officer recently awarded coverage to Butler for cognitive rehabilitation therapy, calling it "medically necessary" after his insurer, Blue Cross & Blue Shield of Mississippi, originally denied his claim last year. The family went through layers of appeals through the course of a year before receiving this final verdict in late April.
"We completely agree this opens the door for 800,000" stroke victims in the U.S., said Susan H. Connors, president and CEO of the Brain Injury Association of America. "Even though this is one person in one state and one insurance company, the one plus one plus one equals many."
Butler suffered life-threatening ailments, a cerebral hemorrhage followed days later by two strokes in October 2010. His doctors later recommended cognitive rehabilitation - essentially physical therapy for the mind - to help his brain catch up to his physical improvements....
Medicare and Medicaid have no national policy for brain-trauma rehabilitation, Connors said, while private insurers' coverage varies considerably.
Blue Cross maintains its denial in Butler's case was based on current medical literature in regard to specific health issues and procedures.
"Medicine is an evolutionary field and we recognize that the agency conducting the independent review of this case has reached a different conclusion as pertains to cognitive rehabilitation. We will abide by this decision and continue to review the medical literature in the future," said John Sewell, Blue Cross director of corporate communications...
"The mayor and Jim learned that there is a very, very limited window of time after a stroke to have this therapy applied," their attorney Trae Sims said. "From a cognitive rehabilitation standpoint, if you miss the window, you don't get it back.
"Fortunately for the Butlers, they had the ability to get him help, but what happens to others who don't," Sims said.
The family's insurance policy is like most Blue Cross policies in that it had the same exception for cognitive rehabilitation, Sims said. "If you suffer a traumatic brain injury by blunt force trauma, as a result of a fall or car accident, they cover it. For any other, like a stroke or aneurysm, they don't.
"It's like Blue Cross is saying 'we'll pay for cognitive rehab therapy but you've got to be injured in the right way.' Talk to any neurosurgeon who treats these patients and they'll tell you as far as rehabbing an individual - from a car wreck to a stroke - the therapy is basically the same..."
Before undergoing therapy, Butler needed round-the-clock care. "It was obvious he was not the same person," Hawkins Butler said.
Now after therapy, Butler, who worked as a homebuilder, is more of the person he was before, she said. "He's driving. He can't work but he has his dignity back, and he has a quality of life...." Article
Timber Ridge is the same place that treated Stuart Irby. I remember seeing him in public before he spent several months at that facility. His speech, motions, and gait were much improved when he returned. Made a believe out of me. Several physical therapists and doctors have told me the key to such therapy in most cases is within the first few months after the stroke or injury. Unfortunately, most people can't afford such therapy if the insurance company won't cover it.
Tuesday, May 15, 2012
Mayor Mary wins a round against Blue Cross
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18 comments:
BCBS is and has been the carrier for the quaint city, it is rated on utilization (premium vs claims)
Will the renewal be justified and extremely large or will they decide not to insure said quaint city?
BCBS is not customer friendly, nor do they care. I have heard BCBS described as the land of misfit toys.
BCBS vs. Mary Hawkins ... oy.
Makes me feel like Truman felt about Nazis vs. Soviets.
Oh no, will BCBS ever be the same? I guess she will meet with the top executives she probably doesn't like the color of blue, just for eyeshadow. Many people have fought BCBS and won but I have never seen it in the news. But they are not opening up an Antique store or running for reelection next year against the bag boy at Kroger. All I know is there needs to be change throughout the COUNTRY!!!!!! And it is best we start here at home!
Good for them! BCBS is scum and they don't care about the people they insure. All they care about is how good Carol Pigott looks.
The 'I hate Mary' asshole crowd has emerged from the sewer.
BCBS has instituted draconian practices toward it's insured to control costs. They limit the type of drugs covered, demand generics in patients who are controlled on brands, make medical offices jump through hoops to evaluate patients with lab test, scans, and procedures. God forbid you need special services, a bypass, stent, a branded cholesterol drug, or some kind of intervention. Don't even mention a preexisting condition, you are on your own for a whole year. It reminds me of the old adage,"Why does a dog lick is balls??? Cause he can."
"Makes me feel like Truman felt about Nazis vs. Soviets."
Or Alabama vs. LSU"
Sorry KF ;-)
@Shadowfax Why do you characterize as an "asshole" rising from the sewer anyone that has anything negative to say about a LONG-term mayor who certainly utilizes shady, if not outright illegal tactics (they're only "legal" until you can prove she used them)? Not-so-subtle intimidation, outright threats, and refusal to fulfill public duties based on the mayor's personal whim or her (for lack of a better term) cronies is rampant. Our quaint city is run not so dissimilarly from a mafia family. Those of us with family members who have been subjected to her don't have that favorable of an opinion of her dictatorial style of governance. Surely I feel sympathy for her family's personal struggle against BCBS, but that doesn't change the fact that she's a public official and is, therefore subject to public scrutiny. It's no secret that there are a lot of people who don't like her. Why would their reaction to an issue that is on the fence be such a surprise? Even the Butlers' lawyer is quoted as saying the policy didn't cover a TBI due to stroke etc. I don't know enough details about the case to speak intelligently, but it COULD appear that she is simply taking the tack that is not that uncommon - she deserves special dispensation.
ok, everyone on here is pretty much bashing BCBS. With some of what they do ticks us off there is something they did for my family. My father was admitted to a local hospital for a possible stroke... long story short... the Dr's found a brain tumor, operated and removed what they could, and he went through recovery. With the expense of the cancer meds, surgery, rehab, etc BCBS of MS stepped in and took care of ALL his claims. My father and mother did not have to worry about anything. My family did NOT ask for this, nor are we "in need" of help but are not well off. When you start bashing them, there are some angels there.
Nuff2Say - I'm glad things went well for your family, but they were jsut doing what you paid premiums for, and what they were contractually ogligated to do. They're not "angels" because they did what they were legally required to do.
They have obstructed necessary medical care for dozens of my patients. They refuse to explain why, and refuse to allow me to speak to a PHYSICIAN as to why they won't cover a medically necessary test or treatment that is the standard of care in the 49 states that have better health outcomes and rankings than this one.
This looks like Mary grandstanding again. BCBS of MS has denied and granted many claims throughout the years and appeals have been heard and won, but never notorized in the paper like the Queen B. I agree the Mary haters are coming out in droves and will be there for the bag boy. It is time for a change in Madison. She and her muscle need to go. John Bell would be a breath of fresh air for Madison and feel he would make some necessary changes in some of the city's agencies.
The thread now morphs to a campaign stop for Johnny B. Since it has, a statement from the opposition seems fair here. What Madison needs is NOT a 'breath of fresh air'. Madison has plenty of fresh air. We have all seen how Crosby operates as a county supervisor. I suggest we don't want that in Madison, The City. Maybe the haters are Johnnies Come Lately to the city. Hawkins literally built the place with tenacity and protective armour positioned to benefit the town, not herself. Had it not been for her hard-ass approach to the job and her (overly) protective attitude, we could look like Pearl or Brandon or Clinton, all lovely little places, yet absent of sensible zoning and plastered with tacky crap everywhere.
To the gentleman who claims to have been done wrong, stating he has certain knowledge of illegal activity, put up or shut up.
Looks like Heath Hall the public relations guy for madison county is at work on this site--
Nuff2Say
I call bullshit, if this were the case the stars have lined up very mysteriously.
There are enough gray areas in their contracts to deny a percentage of most claims.
Either count your blessings are tell us you work on Lakeland drive.
Why is it that everything with Shadowfox is negative and always has to bring up others... Does this make you the big man? King fox and queen Mary please yah deserve each other......
Hey, at least I got my "Healthy U"
@ another Madison-hater @ 6:54:My post was particularly positive. Madison-Positive, Mayor-Positive. What's negative about portraying this town as it is, an enviable respite from the rest of the metro?
I didn't 'bring up' anybody. The people I mentioned (Crosby and Hawkins) had already been mentioned. If my challenge to the poster who claimed 'illegal activity' is 'bringing up others', so be it.
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