INDEPENDENCE, Mo. — Original Post
It’s been nearly a month since a deadly pileup on Interstate 70. A metro man lost his wife in the crash, and now he’s fighting for his life.
But James Henderson’s family says his health insurance company isn’t providing coverage that he paid for.
Jim and Linda Henderson were together for 55 years until fate tore them apart. A pileup involving 47 cars on I-70 on Feb. 15 took Linda’s life and left James in the ICU at Centerpoint Medical Center in Independence.
A Facebook video of the crash went viral as cars continued to pile after winter conditions changed rapidly on the interstate.
“He’s fighting for his life, and he’s fighting for his family. But they’re not fighting for him,” the Hendersons’ daughter, Laura Spooner, said. “They’re worried about money and age.”
Spooner said her dad has Medicare and supplement insurance through Aetna Coventry. She said his doctors are recommending long-term acute rehabilitation, and he should have been transferred to a facility weeks ago.
But she said his health insurance provider is denying coverage for that care. His family has appealed the decision, but both times it was turned down.
“They said if they do the second denial that they’ll pretty much just stamp it and they’ll deny it the third time — and that’s exactly what happened,” Spooner said. “People who have been paying their premiums, people who have decided to take what they call the gold standard, the Cadillac — they should receive the gold standard and the Cadillac service.”
“Every day they have to watch their father slowly fade, and that’s wrong,” said Nick Hinrichs, her attorney. “What’s going on should never happen. When you pay for insurance, you should get that proper care. It’s not happening in this case, and I think it’s not happening to thousands of people across the nation.”
Spooner is represented by the Hinrichs Law Firm and Dollar, Burns & Becker. They believe Aetna Coventry would prefer to move him to long-term care instead of working toward rehabilitation.
“We’ve made multiple calls, sent multiple letters, tried to have sit downs with them to see if they would eventually try to re-evaluate Mr. Henderson’s case, but we’ve received no direct response,” Hinrichs said.
In a statement from Aetna, they indicated a transfer isn’t needed.
“Ensuring our members get the appropriate care is our main priority. Mr. Henderson is currently at an Acute Care Hospitals (ACH) where he is receiving care for his medical needs. Through internal and external reviews, which were based on medical records, Medicare guidelines and MCG LTACH Guidelines, it was determined that there is no clinical benefit to the member in transferring him from the current ACH to a Long Term Acute Care Hospitals (LTACH).
“The member is currently receiving a higher level of care at the ACH and no medical services were identified as being available at the LTACH, that are not available at the current hospital. With additional time in the current facility, clinical stability can be ensured and the member could then be admitted to an Acute Rehabilitation Facility.
“The care provided for the member at his current facility and future services at an acute rehabilitation facility are covered under the member’s plan.”
“Their ultimate conclusion that there is no difference between the ICU and an LTAC is blatantly false,” Henrichs said.
Ultimately, Spooner hopes her dad can get coverage for the care she said he’s paid for over his lifetime.
“My mom is watching over him. I believe that’s getting him through,” Spooner said. “The love of us, we’re there every day. We’re fighters. We’re not abandoning our dad. We love him. We’ll be there every step of the way.”
The family is also asking for get well cards as James Henderson recovers. If you would like to send a card to the Henderson family, please mail it to the Henderson family at P.O. Box 932, Platte City, Mo. 64079.
After the crash, the family set up a fundraising page to assist with mounting medical bills. If you would like to help this family, you can find it here.