Woman lives without portion of skull for nearly four months because of insurance snag

  1. http://www.sfgate.com/cgi-bin/articl...415EDT0666.DTL

    Woman lives without portion of skull for nearly four months because of insurance snag
    ALEXANDRIA SAGE, Associated Press Writer
    Thursday, May 13, 2004
    2004 Associated Press

    URL: sfgate.com/cgi-bin/article.cgi?file=/news/archive/2004/05/13/national1415EDT0666.DTL



    (05-13) 11:15 PDT MIDVALE, Utah (AP) --

    After a lot of red tape, Briana Lane has her skull back in one piece.

    The 22-year-old woman was injured in an auto accident in January, and doctors temporarily removed nearly half her skull to save her life.

    But for nearly four months afterward, the piece of bone lay in a hospital freezer across town -- and Lane had to wear a plastic street hockey helmet -- because of a standoff with Medicaid and the hospital over who would cover the surgery to make her whole again.

    The surgery finally came through after an excruciating wait, during which she suffered extreme pain just bending down and would wake up in the morning to find that her brain had shifted to one side during the night.

    "When you think of weird things happening to people you don't think of that," Lane said. "It's like taking out someone's heart -- you need that!"

    Sonya Schwartz, a health policy analyst for Families USA, a consumer health care group, said insurance horror stories happen every day. But "this particular story is outlandish."

    On Jan. 10, Lane's car rolled over on an icy canyon road above Salt Lake City. Lane, who was not wearing a seat belt, was thrown through the windshield. (She was later charged with driving under the influence and not having a driver's license.)

    Doctors at the University of Utah Health Sciences Center in Salt Lake City removed the left side of her skull to treat bleeding on her brain. Lane's doctor originally scheduled the replacement surgery for mid-March, a month after her release from the hospital, said her mother, Margaret McKinney, a nurse who works in another division of the medical center.

    But the operation was canceled the night before because the hospital was waiting to see whether Medicaid would cover it -- a process that can take at least 90 days.

    Lane, a waitress with no insurance, was sent home from the hospital with a big dent in her head where the bone had been removed but the scalp had been sewn back into place. She stayed at home, able to walk around but not go to work, and had to wear the helmet during the day.

    During the wait for a decision from Medicaid, the hospital could have declared an emergency, moved ahead with the surgery, and figured out afterward who would pay -- the hospital, Medicaid, or the patient. But the hospital did not do so.

    Lane's mother said that she argued with the hospital: "We just want what you've taken away. Can you just give us back the skull and we'll go on with our lives?"

    After months of delay, Lane contacted a local TV station, a move she believes hastened the surgery. "All of a sudden -- top of the list!" she said. The operation took place April 30.

    Exactly what broke the impasse is unclear.

    The operation took place after Lane's mother's insurance decided to cover the surgery, as well as her nearly $200,000 in medical bills.

    But hospital spokeswoman Anne Brillinger, while refusing to comment on certain specifics of Lane's case because of federal privacy rules, said the medical center decided to go forward with the surgery before it learned the insurance would pay.

    Utah's Medicaid program has yet to decide whether Lane qualifies.

    Robert Knudson, director of eligibility services at the Utah Health Department, which oversees Medicaid, said the agency has not yet seen enough evidence to decide whether her injuries entitle her to benefits under the law.

    He would not comment on whether her four-month wait was unreasonable. But he said the decision over how fast Lane should have gotten treatment was up to the doctors, not Medicaid. "We only pay the bills," he said.

    A neurosurgeon at Indianapolis' St. Vincent Hospital, Ronald Young, said such surgery would not be considered an emergency, but is typically performed within three to four weeks -- the swelling has to go down first -- because the risks to the patient are high.

    "There's no reason not to replace that as soon as you can," Young said. "I don't like to have people who are walking not have their skull."

    He added: "For a person who is walking, who is ambulatory, to not have their skull is a problem because you get a lot of brain shift. A simple fall, hitting her head or something could be horrendous."

    Today, Lane's close-cropped hair barely covers the long curved scar on her scalp. The blackouts and dizziness are happening less often, and simple tasks are no longer excruciatingly painful.

    But she said the experience has left her a little more cynical about the health care system.

    "Just because they don't have money doesn't mean they should be treated differently from anyone else," she said. "I'm a good person. I just happen to be not as rich as some of them."

    2004 Associated Press
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  2. 5 Comments

  3. by   Q.
    I dunno. This whole issue of payment is a hot button issue for me. My organization wrote off $32 MILLION DOLLARS this last fiscal year as a result of bad debt. We serve primarily uninsured patients with expensive medical stays - just like this girl in the story. As a result, many of us lost our jobs. Our budget still has to be approved for next year and it hasn't been even AFTER cutting an educator from our 9 person department. More cuts are expected next week, as well as benefit and pay reductions.

    Unfortunately, it's not as simple as this:
    During the wait for a decision from Medicaid, the hospital could have declared an emergency, moved ahead with the surgery, and figured out afterward who would pay...
    Because ultimately, it's the hospital who pays and yeah, she would have gotten her surgery but off the backs of the workers.

    It's a mess, basically.
  4. by   SmilingBluEyes
    A real mess indeed. Imagine being without a skull for 4 months. There are always more than one side to these stories. I would like to ask her why she felt driving DUI and without a seatbelt was advised and who should have to pay for it. However, the girl CANNOT LIVE without her SKULL!!!!! What a mess. I hope she does recover completely.
  5. by   Hellllllo Nurse
    I work w/ Medicare and Medicaide pts who abuse the sytem daily, and don't work when they could.
    I also have seen innocent, hardworking, uninsured people devastated because of a health crisis.

    I just thought it was an interesting story.
  6. by   kmchugh
    Quote from SmilingBluEyes
    Imagine being without a skull for 4 months.
    I dunno. Think of all the people you know who have gone without brains for their whole lives.....
    KM
  7. by   SmilingBluEyes
    roflmao Kev, true true.

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