Family Of EEE Patient Fighting To Keep Insurance Coverage

By Ron Sanders, WBZ-TV

BOSTON (CBS) – The family of a Triple E patient is fighting their insurance company, Blue Cross Blue Shield of Massachusetts, to keep him in the rehab hospital they credit with his progress.

Jeffrey Fuller’s wife Maureen is amazed he’s regained the mobility to catch the balloon their children toss him in a video she made. He was comatose only six months ago, when tests confirmed he had Eastern Equine Encephalitis, Triple E, from a mosquito bite in southeastern Massachusetts, somewhere between Middleboro and Wareham. EEE can cause potentially deadly inflammation of the brain.

Now, Maureen Fuller is upset because she says Blue Cross Blue Shield no longer wants to pay for him to stay at Spaulding Rehabilitation Hospital, citing a lack of progress.

WBZ-TV’s Ron Sanders reports.

“They told me that they don’t feel he’s making the gains that they feel necessary for him to stay here,” she said, adding Blue Cross Blue Shield did not specify the gains they require.

Maureen has been battling with the health care insurer since November after she filed a grievance with them.

“I was told that his discharge date was today,” she said in an interview outside his room Thursday. “We don’t have a facility to send him to at this point…for almost twenty years, my husband’s paid his insurance premiums, hoping that we’d never really have to use them like this.”

“There is no criteria for Triple E and I just don’t understand how someone could do that for a living and play God with my son’s life,” said Fred Fuller, Jeffrey’s father.

Maureen said a case worker at Spaulding helped her appeal to state officials Wednesday.

“He’s made incredible progress…I can’t say enough good things about the facility here.”

She also has great confidence in the toughness of Jeff himself, an avid outdoors man, and said his doctors have been surprised by his progress.

“The doctors may know medicine but they don’t know my husband,” said Maureen.

“He’s gone from comatose to almost standing up,” said Fred Fuller.

Blue Cross Blue Shield gave WBZ a statement Thursday afternoon that read, “We received the appeal from Mr. Fuller’s doctor today. We are committed to providing a decision within 72 hours, after we consult with Mr. Fuller’s doctor and other physicians to ensure he is receiving care in the most appropriate setting. Mr. Fuller’s care will be covered during the appeal process.”

While Maureen Fuller hopes her appeal succeeds so that her husband Jeff can stay at Spaulding and continue his rehab, she also hopes he can walk out of there on his own because of that rehab.


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