Woman With Broken Back Fights Insurance Company From Bed
(SIOUX CITY, IA) A Des Moines photographer is facing an uphill battle with her insurance company after an accident two weeks ago at Stone State Park.
Her doctor prescribed 3 months of bed rest but after being in a rehab center for a week and a half her insurance company was ready to kick her out.
Then her husband called us.
Karen Jaras was supposed to be out of the rehab center today or she'd be on her own for the bills. But after Siouxland News started asking questions, Wellmark extended her stay by at least a week.
But Karen says that's not enough time. She can't care for herself or even go to the bathroom without assistance and because Karen and her husband live in Des Moines, she doesn't even know how she could get home safely.
Stone State Park - it's a beautiful place to visit and because Karen Jaras was in Sioux City with her husband on a business trip, she headed out to the scenic overlook to pass the time.
She was taking pictures when it began to rain. She had climbed down a bit from where her car was parked but on the climb back up she tripped and fell.
"My initial thought was I didn't have my cell phone on me, nobody knows where I'm at and I'm going to die out here," said Karen Jaras.
Karen began crawling on her hands and knees to her car - she finally got to the door, pulled herself up and got in.
She drove herself to the front of the park, despite dizziness and nausea and dialed 911. An ambulance picked her up, and took her to Mercy Medical Center. Dr. Ralph Reeder was the first to see her and his prognosis wasn't good.
"They told me that I had burst one vertebra and that there was nothing that they could do for it," said Jaras.
The doctor suggested 3 months of bed rest and because the couple was 200 miles from home, Karen's Husband began calling around to rehab centers. She ended up at Casa De Paz but a week and a half into her stay, Wellmark told her she had to leave.
"Because of the therapy I'm getting, they said that theoretically I should be able to go home and take care of myself. I can't get up. I can't even go to the bathroom on my own, I can't feed myself. I don't know how I'm supposed to take care of myself," she said.
But Karen says Wellmark wouldn't even pay for a safe ride home to Des Moines. An ambulance ride costs 18 dollars per mile. To Des Moines that's roughly $3,500. Someone at the care facility told her to throw a mattress in the back of their car.
"I think they were just trying to offer up a solution for a bad situation," she said.
Karen's husband works full time and can't quit his job to take care of her. Essentially, Karen says they're stuck.
But Kendall Watkins, a lawyer for Casa De Paz says there are other options.
"If appropriate the facility can assist the family in filing an appeal relating to that coverage at a minimum we're always in a position for providing information for the clinical records, opinion letters if necessary to a family if they're contesting a coverage issue as well," said Kendall Watkins, Lawyer for Casa De Paz.
So what went wrong? It sounds like a miscommunication. The facility is responsible for communicating a patient's status and progress to the insurance company. According to Karen, Wellmark claimed Mercy Medical and Casa De Paz didn't give them sufficient status updates. Karen finds that hard to believe.
Regardless, Karen wants answers.
"I'm sure that my husband's going to want to know what happened. Who dropped the ball, where, I just want to know that I'm going to be here as long as I need to be," she said.
We got in touch with Wellmark, a spokesperson gave us multiple statements, in part:
"It would be inappropriate to provide further specifics on this case in order to protect the privacy rights of the patient. However, it's important to understand that Wellmark does not determine the services a patient needs or does not need - the provider manages the appropriate plan of care for each patient."
We also asked what patients should do if they find themselves in Karen's situation.
Wellmark says start with the customer service number on the back of your insurance card.
But as Karen learned if that doesn't work - keep calling until you find someone who can help even if that means calling us to get answers for you.