Aetna / discontinued authorized treatment
On August 12 my husband was admitted to area hospital for a diabetic wound on the back of right leg and bilateral edema.Prior to his discharge it was determined that he was in renal failure and dialysis was needed.After his first or second dialysis treatment both arms became swollen.Also both knees.I was informed by his doctor that dialysis caused his gout to flare up.He was in so much pain that he screamed when you touched him.He was unable to walk or feed himself.I decided to send him to a area nursing and rehabilitation facility to regain some of the mobility in his hands and legs.He was admitted on August 16.It took the rehab facility until August 28th come up with a care plan.On August 29, I was informed that he was being discharged on the 31.Your company decided he wasn't doing enough to qualify for continued treatment. I was told that I could file a appeal. After speaking to your appeals department.I was informed that Peer to Peer conference was required. The facility informed me that Friday at 6pm they unable to contact anyone for a conference.That following Tuesday morning I was informed that the appeal was denied.When called your corporation to find out who they had did the Peer to Peer with
No one could give a valid explanation. That Monday was the Labor Day holiday. So I know there was no conference. While at the facility my husband's condition worsened. He now had a wound on his coccyx and bilateral heel wounds .All of which was seeping.Iwas I told by his dialysis nurse that he his protein levels was too low for him to heal properly. Also he was in so much pain he could not sit due to his coccyx wound.He was sent to another area hospital for wound care.At that time I requested he be evaluated by their emergency room.Since his ability to speak was now mainly yes or no answers.He was admitted .He now has wound vac on his coccyx and his leg wound.The heel wounds are healing but not enough for him to walk yet.And his swelling has decreased in his joints.He is still unable to feed himself .When I requested he be sent to another nursing or rehabilitation center for additional treatment. Your company denied him admission. I spoke to Amy at your corporate office.She informed me he doesn't qualify for rehabilitation due to his condition. Because he is unable to sit without aid.How is he suppose to sit with a machine attached to his coccyx. And regain use of his hands and legs without proper rehabilitation. I was told to apply for Medicaid for him.But since he recieving his pension and social security pay.His income is too high to qualify for it without putting all his income into a Miller Trust account. Prior to applying for Medicaid. Since your company is refusing to pay for any more services .I have no other place for him to get proper treatment while applying for Medicaid. I am unable to care for him at home.We live in a second floor apartment.which was not problem for my husband prior to this. But impossible now.I also work a full time job.And take my handicap son to his part time job. Home health will only cover limit amount of hours.Am I to leave him alone during those times.I also have some health issues that limits my mobility. So bringing my husband home is not a valid option. Since your company refuse anymore nursing facilities. And I can not bring him home without jeopardizing both his health and mine.Personal pay is not a option. I will already lost half of my household income in order to get him qualified for Medicaid. If I have to use my income as well.My son and I would soon be homeless and car repossessed. Neither one could get to work.I
want someone to call me from your headquarters and explain why I am being put in this difficult position. His prior authorization was so short that nothing was done to aid in his recovery before he was cut off.Now you are denying him any additional services. The letter we receive when this plan was activated by Mittal in 2017.Stated we could decline this plan but with cause a potential forfeit of other services from Mittal.It also stated the Aetna had Medicaid plans.What plans and is my husband able to get them in his condition. Is your profit margin so much.That you are willing to bankrupt me allow him to die from lack of proper care.I sure you don't really care.
So I'm sure there will no reply from your company.But please make sure your CEO get a copy of this.I want him to know how his company is making there billion dollar profits.
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