Recordpub.com - Long-term care questions arise: Paralysis victim is too old for disability, earned too much for Medicaid

Diana Heldt and her 'family'.

By Matt Fredmonsky

Record-Courier staff writer

Diana Heldt can’t afford to wait for national health care reform.

She is recovering from near-complete paralysis, and the financial strain of her medical needs is crushing.

The Kent State University employee has been paying into her insurance through Medical Mutual for at least the past 23 years. For now, the company is paying for her room, board and therapy at Altercare in Brimfield.

That could change Tuesday.

Each week, therapists there review her range of motion and look for new achievements — such as feeding herself — and improvements in strength.

The reviews are forwarded to Medical Mutual, where a case manager determines if the company will continue paying for her therapy.

“If you stop improving, that’s it and you’re kicked out,” Heldt’s son, Thomas Miller, said. “And they don’t tell you until that day.”

Heldt is “paid up” through Tuesday, when her next review is scheduled.

“If Medical Mutual thinks that I don’t (make progress), I’m gone,” Heldt said. “I work hard because I want to stay here. It just comes down to the insurance. There’s something wrong with this.”

Heldt didn’t know, prior to her injury in September, her insurance only offered short-term care and not long-term care, which she may need. And the company has a $2.5 million cap on paying out for treatment related to her injury. The family doesn’t know what the balance is, but medications alone following her surgery cost almost $48,000.

Crystal Davies, a registered nurse at Altercare who handles insurance coverage for patients, said Medical Mutual will pay for Heldt’s stay each year for up to 120 calendar days, which renewed Jan. 1. Room and board alone cost $245 a day at Altercare, excluding therapy, Davies said.

Connie Ralston, one of Heldt’s therapists, said she believes a therapist, and not the health insurance company, should decide whether she can continue benefitting from therapy and should stay.

“I would agree,” said Miller, who spends between 25 and 30 hours a week calling doctors, nurses and the insurance company trying to stay on top of his mother’s condition.

Heldt cannot afford on her own to stay at Altercare. At 61, she has been told she is too old to qualify for Social Security Disability Insurance. As a Kent State employee, she earned too much to qualify for Medicaid.

Medical Mutual also has told Heldt they won’t pay for a home health aid if she is forced to leave Altercare, though the insurance company will pay for a registered nurse to assist her for 90 days, Miller said. After that, she would be on her own.

Right now, the family doesn’t have a plan if she is forced to leave Altercare, but she does have the option to appeal such a decision.

She will remain employed with KSU through June, but then she is likely to take her only option and retire through the Ohio Public Employees Retirement System.

“The most likely situation is that I’ll move in with Tom,” Heldt said. “This has been an eye opener, really. Look into your insurance, because it was a surprise to me.”

5.	Posted by shagbark January 17, 2010
	Tellnitlikeitis, you make such rash assumptions. Mrs. Miller has my sympathy. I thank you for my family wishes. As far as helping others, how I do that is my choice, not the governments. When a government does this through taxes it is no longer charity, but theft. You pointed out many of the reasons plus there are many others. Americans are the most charitable folks in the world because they choose to be, not because the government forces them to be. I believe that choice should be left in the hands of the individual. Just think how much more money you would have to give to the charities you deem worthy if the government was not involved. 100% would go to the cause, not 80% or 90% (if that high)! Onesmallvoice, what is wrong with requiring people to pay their own bills? "She gets to keep a few bucks a month, very little." Is this a "hustle" in trying to get all you can from the government? Maybe another form of "redistribution of wealth?" Or just plain greed in fearing nothing will be left to leave to the kids? I do agree with knowing what is in your policy. Disability and Long Term Care coverage have been available at additional charge for many years. Most folks I've met over the years don't get it since they won't need it.

4.	Posted by onesmallvoice January 17, 2010
	My, how spin works. It is true that the proposed health care reform currently in front of congress would not help this unfortunate woman. She would have needed to purchase additional long term health care insurance. However, it is also true that virtualy no privately obtained health insurance would help her unless she had purchased additional long term care insurance. This is spun by those with an agenda to say that "Obama option would never help the ones who will really need it." What an incredible distortion of fact, likely by a gullible Fox watcher. Not even the public option would apply any more than any standard health insurance policy would. We are also seeing that Medical Mutual has the feared "death panels." Truth is, by Palin definition, all insurance companies do. Again, the perfect illustration of distortion and spin. If only this person were alone in this plight. Alas, she is not. Medicaid (a dreaded "welfare" program of further Republican disdain) has very strick rules about financial capability and would not help until she is very close to completly broke, a genuine possiblity. Medicaid then only pays the amount over what she gets for retirement, not the entire medical bill. She gets to keep a few bucks a month, very little. Besides, it is also another government run health care system and we know how un American that is. But do take her warning, check your health insurance policy. Although I'm sure that anyone who has ever sympathized with someone chanting "Read the Bill" has read their own policy in great detail, you probably already know if you have this coverage because it is almost always an extra.