Terry
On November 3rd, Jack was involved in an off road bicycle accident, he went
over the handle bars, landed on his head, and suffered a contusion (bruise)
the center of his spinal column. The accident left him paralyzed from the
neck down, he is now at Sea Pine Rehabilitation Hospital and looking
forward to recovery. Sea Pines Rehabilitation Hospital is state certified for
patients with spinal cord and head injuries. With intensive therapy, 4
hours a day, Jack will be walking in a few weeks.

The reason for this email is to make you aware of the nightmare we
experienced with our insurance and making to many assumptions with regard
to our benefits. We have a Blue Cross/Blue Shield PPO through our employer, a
group policy with premiums deducted from our paycheck. Four days after
the accident, the Neurosurgeon and Trauma Center Doctors were ready to transfer
Jack from the hospital to a rehabilitation facility, for the necessary
physical and occupational therapy. Great lets get him back on his feet.

Guess what?
Our policy didn't cover an inpatient rehabilitation facility, our policy
dictated that he go to a Nursing Home. Our group policy included coverage
for Sub-acute rehabilitation, not Acute rehabilitation. Sub-acute
coverage is nursing home with minimal therapy. Acute coverage is a facility that
specializes in rehabilitation. It was an emotional nightmare, Jack was
unable to sit-up, walk or feed himself, and then facing the possibility of
sending him to a nursing home was unbearable. Recovery at a nursing home
facility would have been virtually impossible. However, with the help of
the hospital case manager, neurosurgeon, trauma center doctors, and
therapist we filed an appeal with blue cross/blue shield and won. The negotiations
with blue cross/blue shield lasted 9 days a roller coaster event I wouldn't wish
on anyone.

We just couldn't believe our insurance would deny us necessary medical
coverage, This wasn't a situation where our coverage would drop to a lesser
percentage perhaps 60% or 70%. We had absolutely no coverage for an
inpatient rehab (Acute, as its referred). The difference in charges from a nursing
home facility to the rehab center is $1,000 a day. Had we not won the
appeal we would be facing 10's of thousands of dollars in medical expenses.

Please suggest to all members of the FTR to review their insurance coverage
and make sure it includes coverage for acute rehabilitation, for their
protection. We were informed by the hospital case manager, its not uncommon
to send even young people to nursing homes. If they don't have adequate
insurance, there is no choice.

Jack got lucky, although his situation is very serious it could have been
worse, the paramedics were prompt, excellent and did everything by the
book.

Our family and friends have been extremely supportive and we thank them
all, in particular Pete Serra, Max Cole and the Treasure Coast Trail
Riders.

Jack can be reached at 321-984-4600, room 109. His room is equipped with a
voice activated phone.

Address:
Health South Sea Pines Rehabilitation Hospital
Room 109
101 E. Florida Ave
Melbourne, FL 32901

Sincerely,
Barbara Jordan