Grief, Guest Posts

A Moving Letter From A Mother To an Insurance Company After They Denied Her Brain Injured Son The Care He Needed.

April 10, 2014

Beloveds, Jen here. This was a submission sent in yesterday to my site and I felt I had to get it up as soon as possible. I am sitting here in tears. Such love. Such love. Let’s make this viral. Thank you to Demetra for being the daughter you are and sending this in. 

***

My mom wrote this today and posted it to her Facebook account. I think it should be shared with the world so I stole it and am sending it to Jen. My brother, Damon, was in a car accident two years ago and lives with a brain injury. She posted this as a pretend letter to our insurance company… I think it is a good reminder to just be really compassionate and to think about how all of our actions affect others, plus I think it’s beautiful. I hope you like it. I put her bio in with the article and also attached a photo of her and my brother. Thank you, Demetra Szatkowski.

***

I’d like to meet you. I’d like to understand better. I’d like to know who you are.
 I’d like to know if you have legs that work, a body that responds, a fully functioning brain. I’d like to know if you think twice before standing up, before walking to the bathroom, before reaching up and opening the kitchen cabinet. I’d like to know if you go for a run after work, ride a bike, hike, or just stroll through the woods. I’d like to know if you know what it would be like if you couldn’t do any of those things. I’d like to know if you have ever remotely known anyone with a disability and if you have ever felt even one ounce of compassion.

I’d like to know if when you slammed the rubber stamp of total denial down on our request for the power chair that offers the option of standing and seat elevation for my son, providing so many degrees of independence, you thought outside the box at all. I’d like to know if you even tried to come up with a solution or a compromise that would be in the best interest not only of your company but my boy, as well.

Your words: “Denied completely because based on the medical director’s scientific and/or clinical judgment, the documentation shows this service, group 4 power wheelchair and accessories, is not medically necessary. The power standing feature and power seat elevator are noncovered because they are not primarily medical in nature. THESE ARE CONSIDERED CONVENIENCE ITEMS. Therefore, this request is denied.”

I’d like to know why standing and reaching and living more normally are a convenience. I’d like to know why weight bearing on those legs, independently, without needing the help of an outside person, helping them to regain function, is not at all medical. I’d like to know if you think using your legs is just a convenience. Do you think that wanting a multifunctional higher end chair is the same as wanting a high-end sports car? Do you think we are greedy in asking?

I understand that the chair costs as much as a new car. And we are more than willing to fund as much as we have to. I just don’t understand though, if you are willing to pay for any type of wheelchair at all, why those funds cannot be used towards the purchase of this chair, with us making up the difference. I am not even asking you to spend a dime more than you would on the other type of chair. I’d like to know why when you saw the chair model you immediately denied it and will not compromise. Why not price the lower end model and offer us that amount toward the chair? I am naïve to your reasons. Please help me to understand.

Your use of the words, “convenience items” honestly makes me sick to my stomach. There are other words….there are other ways.

I’d like to know if you know that if we based our outlook on other doctors’ “scientific and/or clinical judgment” a couple of years ago, our son would not be here today?

No matter what we have to do, my son will get the chair that is best suited for him. We won’t compromise. I wish you did.

I have no respect for your “scientific and/or clinical judgment.”

 

Never mind. I don’t want to meet you.

***

Karen Pyros-Szatkowski is a full time caregiver, nurse, cleaning lady, cook, and the best mother in the world all in one. Her 19-year-old son, Damon Szatkowski, was in a car accident a little over two years ago and lives with a TBI (traumatic brain injury.) She is also the mother of two beautiful daughters (can you tell her daughter wrote this bio?) You can follow her story or contact her through

Facebook, or at kpszat@aol.com.

mom and damon

 

Jennifer Pastiloff is a writer living on an airplane. She’s the founder of The Manifest-Station. She’s leading a weekend retreat in May to Ojai, Calif as well as 4 day retreat over Labor Day in Ojai, Calif. All retreats are a combo of yoga/writing for all levels. She and bestselling author Emily Rapp will be leading another writing retreat to Vermont in October. Check out her site jenniferpastiloff.com for all retreat listings and workshops to attend one in a city near you. Next up is Dallas, Seattle and London July 6. (London sells out fast so book soon if you plan on attending!)

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20 Comments

  • Reply marcyrin April 10, 2014 at 11:33 am

    I cried even harder when I saw the picture. My son looks about the same age, and insurance has decided that inpatient rehab is not medically necessary for my son even though he is addicted to heroin and suicidal. Thank goodness for a compassionate rehab facility that is working with me on cost. It is disheartening how the dollar sign trumps compassion and basic morality.

  • Reply Mandy April 10, 2014 at 12:08 pm

    This story will anger a lot of people. Its just wrong in so many ways. I experienced trying to get mental health care for a child and it was virtually impossible. Thanks for posting this.

  • Reply barbarapotter April 10, 2014 at 12:48 pm

    Wow as a mom and as a human being this story brought tears to my eyes too.
    bureaucrats suck .

  • Reply Ray Shea (@raynola) April 10, 2014 at 1:34 pm

    You should name the insurance company and blast it all over Twitter. They don’t respond to much but sometimes they respond to bad PR.

    • Reply Darren MacKay April 10, 2015 at 1:34 am

      I was thinking the Same thing- What is the name of the Insurance Co.? So Many Systems that let us Down- but I think the Biggest is the Government!

  • Reply Amie Lamm-Griffin April 10, 2014 at 1:43 pm

    I know my own battle with insurance over being approved for a medication that could stop arthritis from destroying my joints was long long long. And too late to prevent the damage to my hands and feet that make it now impossible for me to work in any profession I have schooled for.
    I pray for a reconsideration for your son! Being able to care for yourself should not be a “convenience”!!

  • Reply Maggie May Ethridge April 10, 2014 at 2:27 pm

    I wish we knew the name of the insurance company so we could leverage the pressure.
    Shared.

  • Reply A Moving Letter From A Mother To an Insurance Company After They Denied Her Brain Injured Son The Care He Needed. | nikebottalico April 10, 2014 at 2:59 pm

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  • Reply Wanda Canada April 10, 2014 at 4:59 pm

    Just wondering if she has checked with a organization like Alabama head injury foundation this is why we as caregivers need to rise up against these laws insurance companies because living with TBI is a national epidemic if people only knew how many people that live with a brain injury is really over whelming my grandson lives with TBI and I am his voice. This could be anyone anytime anywhere that is AHIF motto March is TBI awareness. Spread the word this could be your family at any moment in a blink of an eye

  • Reply Kathy April 10, 2014 at 7:00 pm

    I think you need to share the name of the insurance company. As people are selecting their insurance it would help them and harm the company when they are not chosen. My husband had a simular experience on a much smaller scale with United Health Care. He needed a bedside commode after a massive stroke. The standard size was too small for his 6’3″ height. The seat was so small he had to hold a urnial with his only working arm. I requested a bariatric chair that had a normal toilet size seat so he would not have to use the urnial. They refused because he was not overweight. I ask if they would pay just the amount they would give for a standard size and I too would pay the difference. I was told they would not it was their policy. I think it is time for some policy changes. I can only suggest that you get the best one they have to offer you and sell it to get what he needs. I pray that someone wakes up and uses some common sense when making these decisions. I pray he gets his chair maybe a benefit would help. God Bless

  • Reply angelansmith121 April 10, 2014 at 7:47 pm

    Reblogged this on Angie Nicole.

  • Reply joyce April 10, 2014 at 9:06 pm

    I.understand the pain she is going thru I am going tru the same thing not with my son but with my husband he is suffering with a traumatic brain injury himself and it is a struggle everyday the insurance company are denying his treatment and says the treatment.he was receiving does not work.and they are not putting out the money to pay for a treatment that does not work .I asked them if they had the treatment or where they the doctored or where they my.husband who.started to live a little and be independent but they just keep denying ..let stop.them.are get the treatment they all neec weather wheel chair or never block.I.will.fight.till.the end ..and I also have shared ..

  • Reply The Insurance Company Denied My Brain-Injured Son The Care He Needed Because Of “Convenience Items” | Thought Catalog April 11, 2014 at 11:10 am

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  • Reply viewsplash April 12, 2014 at 1:46 pm

    Reblogged this on Views Splash! and commented:
    This is really touching and lets all hail for Damon and pray for his quick recovery! Lets make it viral people… I know I’m a bit late!

  • Reply ranu802 April 12, 2014 at 2:09 pm

    The policy of the insurance companies keep changing according to their convenience they do not care about the patients their only concern is how much profit they can make. It makes no sense to say it is a convenience item when the patient needs it for his well-being. This is the reason we buy insurance so when the need arises the company would provide it.

  • Reply chattinatti April 12, 2014 at 2:12 pm

    My heart is full…full of compassion. Your story touched me and I’ve shared it with everyone I can. I hope you and Damon continue to be strong…in fact, your whole family. I hope he gets the chair he needs. I’ sure he will. Keep the faith. <3

  • Reply Linda Arthur Tejera April 12, 2014 at 5:35 pm

    I do hope this letter is sent to the insurance powers that be, including the State insurance governing group, oh, heck, I just hope the world sees this. I’m sick of these demi-gods sitting in their little cubicles with their rubber stamps deciding people’s lives. Sorry, for the rant. I pray for this family and others in similar situations. And I pray for those insurance people who make these decisions.

  • Reply davisrayn April 12, 2014 at 7:24 pm

    This is a very moving story, it really grieves me the people who work in these companies can be so one track minded and unflexible

  • Reply beautyfromwithin2out April 18, 2014 at 2:45 am

    I pray that someone reads this and gets me on a plane to this young mans home, because i beleive with the right care and rehab great thinngs will happen in this man’s body! Maifestation prayer being said. Blessings x

  • Reply Kate Flood April 24, 2014 at 5:56 am

    Damon, Karen, Jennifer & Family – I am so sorry this happened to you Damon and to your family. I am doubly sorry you are having to deal with a corrupt insurance system. I hope that you have an experienced Lawyer specializing in TBI handling your medical benefits claim. Insurance companies tend not to pay what you are actually entitled to until a lawyer is representing you with a threat of more loss of money to the insurer. It is rare that a claimant would not win and receive the full medical benefits Damon is entitled to and get the tedious, senseless, draining task of paperwork, red-tape, assessments and insurance negotiation off of your back. How do they expect you to handle that full-time job on top of caring for your child full-time.

    God Bless ~

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