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Fight to recover turns into insurance battle for man with Locked-In syndrome

Updated: Wednesday, July 16 2014, 02:28 AM EDT
CINCINNATI (Paula Toti) -- Brett Walls has locked-in syndrome.

He is fully aware of what's happening around him but locked in his own body, paralyzed.  The therapy he needs to continue improving is within reach but his health insurance is refusing to cover it.  The family of Brett Walls got a letter Friday from United Health Care that said he was ready to be discharged from Drake Hospital and coverage would stop Saturday.  It said that level of care, acute care, was no longer needed.
   
The problem is the 'what's next' is very uncertain.  Tuesday Brett Walls was able to move his right fingers and show arm resistance.  His family was told when he entered Drake Hospital in the spring after a series of strokes not to expect even that.  When Local 12 saw him a few weeks ago starting to breath on his own it was a good thing medically.  But United Health Care said  it now means he needs to be discharged.  If the family wants to get him more care they have to pay out of pocket.


Brett's wife, Gayle Walls, said, "Although he's made progress and beaten the odds and we'd love him home ASAP, he's a long way from that point."

Brett is fully aware of everything around him and communicates with eye blinks and a chart.  He still has limited mobility and needs a feeding tube for most of his nutrition.  Gayle thought she had the solution for the next step, taking him to a skilled nursing facility.  But their policy called for 60 days of coverage.  After several appeals she was denied this step.

"They deemed him custodial care, maintenance only.  He's ready to go home," Gayle said.

The insurance company has denied the skilled care saying he would not benefit. Gayle said a hospital and one specializing in locked-in syndrome in Chicago felt Brett was a good candidate for rehabilitation therapy.

Vicki Harris said that after recovering from locked in syndrome 25 years ago she was given six hours of rehab a day.

"He's right there and I don't understand why they are denying him therapy," she said.

Harris had much less movement than Brett.  Gayle said her husband worked his whole life and paid for health insurance, "And he did so so if the ground would quake beneath him he wouldn't fall into that hole.  I feel they're pushing us deeper."


United Health Care issued a statement that said, "We recognize the devastating nature of this diagnosis for Mr. Walls and his family and we are working closely with them to provide additional support and make sure his family is prepared to help care for him."



Follow Paula Toti on Twitter @paulatoti and LIKE her on Facebook Fight to recover turns into insurance battle for man with Locked-In syndrome


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