Karen Strack, a former UC Davis employee with the Department of Food Science and Technology, is currently battling her health maintenance organization (HMO) to retain funding for medical rehabilitation after being diagnosed with a rare neuropathy known as Guillain–Barré syndrome. Health Net, the insurance company utilized by the University of California for its retirees, is threatening to cancel Strack’s coverage due to insufficient progress with her illness.
Although she is still receiving treatment after an appeal, Strack states that Health Net is actively trying to cancel her coverage.
A document warning of her impending payment termination was issued on May 23, just 21 days after she checked into the Woodland Nursing and Rehabilitation Center for nursing services and physical therapy. Strack had also been receiving IV injections of immunoglobulin at Sutter Health in Sacramento for almost a month.
“Your Medicare provider and/or health plan have determined that Medicare probably will not pay for your current skilled nursing services,” the document stated. “Patient is working with Physical and Occupational Therapy and has reached a plateau in rehabilitation.”
Her termination date was set for May 25, two days after it was delivered to her at the Woodland facility.
Strack’s Medicare plan is currently managed by Health Net, an option that many insurance providers offer to recipients in order to find money-saving options with their coverage.
“I chose Health Net because I couldn’t afford Blue Cross,” Strack said. “Since I was diagnosed, I’ve been fighting and fighting for my coverage.”
A case manager is assigned to each patient receiving Health Net benefits, who overlooks patients’ files based on physician assessments and determines authorization for further treatment authorization. If they determine a patient has received enough treatment, their funding is terminated and healthcare providers are forced to stop providing unless the patient can pay on their own.
Strack is adamant that her dismissal is not founded on physician assessments advising her dismissal.
“The doctors are not saying to send me home. They assured me that they’re not trying to let me go,” Strack said.
Ben Piper, administrator at Woodland Nursing and Rehabilitation Center declined to comment on the specifics of her case.
“We’re providing her company and hoping she gets the support she needs,” Piper said.
A physical therapy evaluation sheet, filled out when Strack was first admitted to the Woodland Nursing and Rehabilitation Center, maps out long-term goals for her treatment. Among them are the ability to “safely [perform] bed mobility tasks with independence without use of siderails,” “safely perform functional transfers” and “safely ambulate on level surfaces 350 feet … ”
When first diagnosed, Strack was unable to speak, walk or move her limbs. Since then, she states that she has made considerable progress. However, Strack says that she still cannot walk on her own or perform everyday tasks without assistance.
“I can’t use the toilet by myself, I can’t take a shower by myself — in most states, it’s illegal to send you home without being able to take care of yourself,” Strack said.
Despite this, Health Net and Strack’s case manager have decided that she does not require additional treatment at the facility.
Brad Kieffer, media and public relations officer with Health Net, declined to comment on the specifics of the case, citing federal regulations for patient privacy.
Strack and her son Scott will continue to appeal for her retention at the facility. They are unsure whether or not their funding will be cancelled on a week-by-week basis.
“This is an absolute tragedy,” Scott Strack said. “I can’t believe they’re trying to pull the plug. She’s supposed to continue therapy at home when she can’t even get to the toilet or get to bed on her own.”
Strack feels that her Health Net is neglecting her need for rehabilitation with a full-time staff for the sake of profit.
“If you’re not progressing at a certain pace, Health Net [doesn’t] care about you. They don’t care about relapses, they only see progression. I worked at UC Davis for 36 years — this is totally unjust. I am not going to make my son bathe me, and wipe me down after [using] the bathroom. I’m just not going to do it.”
ADAM KHAN can be reached at firstname.lastname@example.org.