JON BROOKS: What sort of care is the insurance company still paying for?
BONNIE STOW: Outpatient therapy, but it's been cut to 30 hours of physical therapy, speech therapy and occupational therapy each for the entire calendar year.
JON BROOKS: Can you tell me who the insurance company is?
BONNIE STOW: Well, we got a lot of responses from people who were not happy with the insurance company and we don’t want to make the situation worse by people contacting them directly.
JON BROOKS: Are you in negotiations?
BONNIE STOW: We haven't gotten to that point yet. We've never dealt with this, so we don’t know what avenue we should take.
JON BROOKS: What was the reason you were given for the company no longer paying for the facility?
BONNIE STOW: We were told insurance companies will only continue to pay as long as there are signs of improvement and progress. And the second a patient starts to plateau, they’ll stop paying. But now he’s gotten to the point where he’s taken a big step back.
JON BROOKS: How has he declined?
BONNIE STOW: Even transferring from his wheelchair to his bed is painful. His body stiffens up if he’s not continually moved, which is why we’re trying to stand him every hour for two minutes. But with the lack of therapy, he’s gaining weight, which makes it harder for us to do that. At the live-in facility, he was also getting psychological therapy, which he doesn't get now.
JON BROOKS: So who is taking care of Bryan at your parents' home?
BONNIE STOW: My parents hired someone for three hours in the morning to get him up and showered, and three hours in the evening. My mom feeds him.
JON BROOKS: Is that covered by insurance?
BONNIE STOW: No. It's $25 per hour.
JON BROOKS: So that's $150 per day, or about $55,000 per year. Have the donations you were receiving after the attack slowed?
BONNIE STOW: Yeah, but I don’t want to take away from the donations we are getting. Of course they help.
JON BROOKS: Are the Giants helping out?
BONNIE STOW: Tim Lincecum donated to his fund in the beginning and Barry Bonds donated money for the kids' education. We get texts from the Giants to make sure we’re doing OK. Tim Flannery did a couple of fundraisers. They treated us to the World Series game. They’ve been supportive in making us feel like part of their family.
JON BROOKS: How is Bryan doing in terms of his overall recovery?
BONNIE STOW: Well, he lived. That's big progress. His memory is pretty good. He has moments he doesn’t remember what he had for breakfast. He’ll sometimes use a word that's not what he meant to say, and it doesn’t make sense. But he’s doing really well when you look at him. His body just needs to catch up. And, in order to do that, he needs his therapies.
JON BROOKS: And how well is the family coping now?
BONNIE STOW: I feel like this is a different chapter. We’re all in Santa Cruz County, so we’re all here and we’re able to help, so we have the support of each other. We’re coping in the sense that we’re together and we’re doing it as a family.
A Common Situation
This is a situation no one ever plans for, of course. I asked Karen Pollitz, a senior fellow at the Kaiser Family Foundation who specializes in private health insurance, how often someone who is seriously injured gets sent home from a live-in facility. Stow is still covered by his employer through COBRA, and Pollitz said job-based insurance limitations on coverage for rehab services are common.
"One common limit is on days or rehab visits a plan will cover in a year or relative to a particular accident or injury. The second (is that) plans will only cover care that’s medically necessary, and the definition of that with respect to rehab may have something to do with whether you're still on a trajectory to return to the level of health and function prior to the injury or accident."
But, Pollitz said, there is no definition of what's "medically necessary."
"This has been a long-running discussion," she said. "What should be the standard for covering medically necessary rehab services that are required over the long term? Is it that you’re eventually going to get better, eventually achieve a certain level of improvement, or is it to prevent further deterioration?"
I asked Pollitz whether the Affordable Care Act, which goes into full effect in 2014, could help Stow. It won't, she said. The 30 hours per year for different rehabilitative services that his family says Stow is now approved for is similar to the standard that plans offered through California's health exchange will operate under. So, even though people like Stow, who have a long-term injury, will be able to buy insurance, they would still run into the same limits on rehab services.
So what do you do when an unthinkable tragedy like this strikes? The Stow family is fortunate -- if you want to call it that -- in the respect that the attack received so much publicity that donations were able to help defray the cost of his recovery. And of course, they may or may not receive money from the Dodgers through their lawsuit. But not everyone gets a fundraising video made on their behalf by Barry Bonds.
Pollitz said the best option for people in Stow's situation who can't afford long-term care may be Medicaid (Medi-Cal in California), which has no limits in getting rehabilitative services at a live-in facility.
“One of the huge differences between Medi-Cal coverage and private insurance coverage is that (Medi-Cal) doesn’t limit these services, either for medically necessary reasons or dollar limits. This distinction between (what's) care to improve or care to maintain ... that gets blown away under Medicaid. It's all covered."
That might, however, require "spending down" -- reducing your assets in order to qualify for the program.
We'll check in with the Stow family as events develop. For now, here's a video they posted that documents Bryan's recovery ...
