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Stroke Survivor Battles Insurer for Crucial Rehab Coverage
14 Aug
Summary
- Stroke patient denied coverage for intensive rehab by insurer Aetna
- Delays and miscommunication led to downgraded rehab program
- Patient left with permanent damage and $150,000 hospital bill
In June 2024, John Karadell suffered a stroke and was admitted to the hospital in Howell, Michigan. His doctors immediately recommended he undergo intensive rehabilitation, known as acute post-stroke rehab, to aid his recovery. However, Karadell's insurer, Aetna, denied coverage for this treatment.
Over the next month, the hospital and Aetna engaged in a back-and-forth, with the hospital submitting appeals and Aetna repeatedly denying the request. During this time, Karadell remained bedridden in the hospital, his condition deteriorating. Finally, after more than a month, Aetna approved the intensive rehab, but by then Karadell had given up and opted for a less intensive program closer to home.
Karadell believes the delays and denials by Aetna have left him with permanent damage, including numbness and difficulty with basic tasks. He was also left with a $150,000 hospital bill, which the insurer and hospital are still negotiating.
Experts say Karadell's experience is all too common, as insurers often use tactics like repeated denials and complex appeals processes to limit spending, a practice known as "rationing care by inconvenience." This can have serious consequences for patients, both in terms of their health and their finances.
