Doctors say teen needs brain rehab, insurance says nursing home



Posted on September 14, 2010 at 11:09 PM

Updated Wednesday, Sep 15 at 4:27 PM

Zoey Abel is a vibrant and outgoing teenager. A recent Peninsula High School graduate, she was a soccer star and served as a camp counselor.

But three weeks ago, everything changed.

"You get the every parent's dread phone call at three in the morning. You get up. You do what you have to do," says Brenda Abel, Zoey's mother.

Brenda learned her daughter had been severely injured in a car accident. She was tossed from the car while the driver literally walked away. Zoey was rushed to Tacoma General Medical Center with a broken leg, a damaged kidney, and a head injury. That weighed heavily on Brenda and Matthew.

"You are carrying a load so heavy but you are managing it," says Brenda.

In the following days, Zoey's condition improved. But the head injury will require rehabilitation. Her doctors believe she needs intensive specialized inpatient rehabilitation, which includes speech and physical therapy.

"They all tell you the next step is inpatient rehab, aggressive inpatient rehab," says Matthew. "Every day, every therapist she sees, all the trauma doctors, everyone that's dealt with her here has said that's where she needs to go to."

But her insurer, Group Health, denied the request, saying she should go to a nursing home.

"They want to put her in with geriatric patients where she will receive minimal rehabilitation 3-to-4 times a week, maybe. That's the best thing for my daughter. That's what they are telling me. In the same conversation, they are telling me skilled nursing is half the cost of inpatient rehab," says the angry father.

Then Brenda and Matt called me with more crushing news.

"Earlier this morning, they rejected the urgent appeal." Matthew said. "That was it. They were done with it."

I immediately went to Tacoma General. Matthew made sure Group Health knew I was coming.

"I told her you were going to be in the office in 82 minutes," he said.

By the time I got to the hospital, Matt had good news.

"We get a phone call about 25 minutes later from the person who refused the appeal earlier this morning, saying they had a clinical exception in this case and she's been allowed for 21 days of inpatient care," he said.

Brenda couldn't be happier.

"I just started crying. It was like we just climbed the top of a mountain. We just want our girl to get better," she said.

A few days later, the family took video of Zoey's move to St. Joseph's Hospital. Her doctors there say she's making exceptional progress.

"She's gaining every day. That's what you have to accentuate. She's learning. She's doing everything she needs to do. She's working hard. She's focused and having fun," said Matthew.

Group Health says federal law won't allow them to talk about Zoey's case, but they did say, "We're sorry when any of our patients or their family feel they didn't have a good experience at Group Health."

By the way, Zoey's doing so well, she's texting now.