Sunday, April 20, 2014
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Gail Kennett, now in the late stages of Lou Gehrig’s disease, has been a critical-care patient at Maine Medical Center since February 2012.
"Unable to accommodate taking care of patient," replied a representative of St. Andre's Health Care in Biddeford. "I don't know of a facility that could take care of her."
"We can't and do not know of a sister facility that could," echoed Lakewood Continuing Care in Waterville.
The Kennetts' plight, to be sure, reveals a gaping hole in Maine's health care delivery system: If you're on a hospital ventilator and your condition is too complex for home-based care, you stay put or you die.
(In an email last week, Maine Department of Health and Human Services spokesman John Martins said "there have been discussions with Genesis Healthcare and Maine Medical Center regarding a proposed model to provide these services" in a skilled nursing care setting, although many business and regulatory hurdles remain before that becomes a reality.)
But beyond the system's inability to handle Gail, it's hard to fathom the world to which John Kennett awakes each morning: Throughout all those decades teaching Maine kids, he thought he and his wife would have adequate health coverage in their twilight years; now he finds himself a soon-to-be widower and in debt more than a million dollars.
And the company he once thought would follow him and his wife to their graves now advises in its most recent denial letter to the Kennetts, "Even though benefits are not approved for your continued inpatient stay, we recommend that you consult with your provider to determine the care and/or treatment you may need."
Seriously? That's the best they can do for a woman who's spent her life volunteering for everything from her local schools to Habitat for Humanity and the Alzheimer's Association?
"Based on the policy and the criteria and the review process ... the care is currently custodial," said Anthem spokesman Christopher Dugan last week after looking into Gail's case with the family's permission.
John Kennett had the good sense to purchase long-term care insurance to supplement his and Gail's Anthem health policy, but the $220 per day currently paid to Maine Medical Center by MetLife (which has no problem recognizing the necessity of her treatment) amounts to less than 10 percent of her daily hospital bill.
And while there's always the chance that seven-figure outstanding balance ultimately will be written off to "bad debt" or "charity care" by Maine Medical Center once the Kennetts' last-ditch appeals (and, if necessary, federal lawsuit) run their course, that's small comfort as John kisses his wife around midnight each night and heads home to their empty house in Scarborough.
"We have been dealing so much with (the insurance dispute) that we can't focus here, where we should, to make sure Mom's comfortable and enjoy the time we have left," said the Kennetts' daughter, Allison Kennett Conti, motioning toward her ever-attentive mother last week. "We're just so focused on emails, phone calls, red tape and bureaucracy."
Late last summer, before Anthem finally agreed to cover Gail's hospital care until Sept. 22 but not one day more, the Kennett family requested a meeting of everyone -- the doctors, the nurses, the administrators, the social workers, the insurance company -- to try to find a way out of what Anthem's outside experts so accurately call her "dilemma."
"We had the meeting at the hospital and Anthem was aware of the meeting, that they were invited to come and be part of it," recalled John. "But they didn't show up."
Must have been too "problematic."
Bill Nemitz can be contacted at 791-6323 or at: