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.

  • florencenightingale

    good luck to the fullers, both in their fight against blue cross, and his ongoing fight to regain the abilities eee took from him. i encourage the fullers to get the support of elected officials, and the media. having worked for managed care companies (altho not blue cross), i am aware of the bureaucracy that surround these appeals. if this appeal doesn’t go your way, take it to the division of insurance. good luck, and i’ll be watching from ny.

    • Jeanette Fuller

      thank you florencenightingale

      check out our facebook page “One Million Strong for Jeff Fuller”

  • emom

    I know how Maureen feels, she has a huge fight on her hands, I have had to deal with struggles for my husband when he became ill, Thou my situation is much different, its not much different..
    Maureen , fight for all your husbands rights, fight for your families rights, fight for the care for your husband to help him get better… I watched this video and I am truly amazed at how well he is doing.
    That to me is progress. DON’T LET ANYONE TELL YOU OTHERWISE. Yes your journey will be very hard and difficult. His journey will be challenging, but your love and the children’s love will encourage him and help him along the way.. The insurance industry is difficult to deal with, But stand your ground and get them to hear you , show them and make them help as much as possible.
    As I said I have been there and still deal with the insurance companies to be sure they pay charges they are to pay… Please look up the Massachusetts insurance state laws, they can come in handy .. Keep the faith , love and strength , and all the blessing to you and the family … prays to all for a speedy recovery. :-)

    • Jeanette Fuller

      Thank you for the words of wisdom!
      Check out our facebook page to show support!

      “One Million Strong for Jeff Fuller”

  • Bruce McClure

    Maureen is a high school classmate of mine. I just want you to know I’m praying for you and yours, Maureen. Big blue insurance needs to be stopped from doing terrible things such as this!!! Hang in there.

    Praying for you.

  • Italo

    I hope Maureen fights this, too. The reason this is being done, is because the facility and the insurance company will want her husband out of there if, over a certain amount of policies-determined time, he is not showing the level of progress that is expected for him to qualify for rehab stay coverage. He doesn’t do what the policies dictate, then none of them get paid or reimbursed as expected. And Maureen: any hospital dischargist is ultimately working for them and their benefit, not your and your husband’s — so keep on fighting, including checking with local caregiving agency support services and resources, if you have to. I hope everything works out well for this gentleman and his family! :)

  • Mark

    May God Bless you in this fight, and don’t give up. Insurance reform must get even stronger this is inhuman!!!!! Until we as a people realize that the insurance company’s don’t care about us things won’t change. It’s the money always the money. Unfortunately there is all to many cases like this that we don’t even hear about. But we should, so we can get good and mad and stop this money grabbing industry once and for all PEOPLE.

  • Kevin Cox

    god bless from the Cox family thinking and praying for your family

  • sue

    What a horrible situation that BCBS is putting this poor family through. All those commecials about member services and being ‘for the members’ – really? I hardly doubt the CEO works as hard as this man. He should be ashamed for allowing himself such a salary when members struggle like this. How does that man sleep on his gold-covered pillow at night is beyond me.

  • Kelly Cannon

    Maureen I am a friend of Kristen Suplee-White and my husband and I are praying for you. I was in a simular situation this summer. I was paralized after surgury on my spinal cord. I was in Braintree Rehab for 60 days. On day 57 my husband was told I had to leave on day 60 because of my Blue Cross Insurance. We didn’t have the time to fight for me to stay. He moved me to a nursing home our only choice. Please stay and fight. Once I left Braintree Rehab I was on my own. It really sounds like Jeff needs the Spaulding Rehab. Any progress is worth it!!

  • TheDudeLebowski

    I applaud WBZ for covering this story. I recently donated to a benefit for his fight. I have never met him but the dedication by his wife and the support his family and friends undoubtly shows how much he is loved. I wanted to do something for someone that is cared by so many. Please WBZ continue to cover this story and let us know how to help. Jeanette keep up the great work and know that there are not only his numerous friends but complete strangers willing to help you.

  • Jeanette Fuller

    Thanks TheDudeLebowski. My family has received so much support already and we couldn’t give enough thanks to everyone that has helped. I wish the man sitting behind the desk at Blue Cross could see the look on his face when his kids walk through the hospital door. They would know that this is all worth it. Look out for an upcoming event in June! We are starting to plan a 5K race (and walk)!

    Also, this is a link to the facebook page.!/pages/One-Million-Strong-for-Jeff-Fuller/163208817063902

  • John

    I find it unbelievable that an insurance company that has very willingly taken this family’s money during the good times could so callously come to the conclusion that their bottom line (which I seriously doubt this case is effecting) is more important than the welfare of these people! This man most likely paid a higher premium than most due to his occupation, becomes ill through an unlikely source and no increased risk (If I recall correctly, the man was golfing when he was bitten for goodness sake!!). Now, within 6 months of being in a coma, he is standing, talking and getting closer to being self sufficient, the insurance company has the gall to say this isn’t enough to justify continuing to keep him in a rehabilitation center and that he should just go sit in a hospital and hope he gets better on his own? Shame on you BCBS! I urge everyone, especially the BCBS decision makers, to imagine how you would feel to be in their shoes, that would be a painful mile to walk indeed. Thank you WBZ for covering this story, and please continue to update it as it moves forward.

  • shaw

    Your family is in our prayers Jeanette. I find it horrible that BCBS couldn’t even take their time to put their face on camera to explain their decision. I’m sure they have their reasons but this is why we all feel like a number to them. I hope they come back and prove me wrong……

  • pat

    Keep up the good fight against the evil Blue Cross. No one deserves to be treated like that, especially when they’re hurt or sick.

  • MDS

    Fight the good fight… there are a lot of people pulling for you guys!

  • Why is Jeff Losing His Health Insurance Benefits?

    […] Family Of EEE Patient Fighting To Keep Insurance Coverage –  The guy in this article used to frequent a homebrewing online forum that I also belong to.  Last Fall, he came down with Eastern Equine Encephalitis which is a mosquito-borne illness that causes swelling of the brain.  He was in a coma for months but finally came out of it and has been battling his way back, learning to talk, eat, and interact with his family all over again.  And now, Blue Cross Blue Shield is trying to cut off his benefits because he’s not making enough progress.  Of course, they can’t seem to articulate the actual standard they’re measuring his progress by. […]

  • Steve K.

    Thanks, BZ, for keeping us alerted to the type of health care issues we have to face these days.

    Jeff, I have heard that you are recovering steadily and surpisingly well. I hope BCBS allows you to focus on your rehabilitation.

    I, too, have BCBS. I shall be watching their decision-making process.

  • SCA

    That’s insane that BCBS is trying to cut him off after 20 years of paying into it. Despicable

  • Jesse Christensen

    Thank you for covering this story, and please do a follow up on this story as the “removal date” approaches!

  • Sean Revers

    Thank you so much for covering this story, its scary to think you can pay in for many years than when its there turn to pay they can just say nope to bad. I hope jeff makes and full recovery and bcbs lets him stay to make a full recovery. Please do a fallow up on this story the world needs to hear about this and i want to hear about jeff`s recovery.

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    Family Of EEE Patient Fighting To Keep Insurance Coverage « CBS Boston

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    Family Of EEE Patient Fighting To Keep Insurance Coverage « CBS Boston

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