Steve's insurance company, CIGNA, began pushing him to have Marian discharged to a long-term hospital. "It was the worst thing I could have done," he said. "It was like something from a third world country." Before even receiving the records from Tampa General, Steve said the neurologist at the facility characterized her as a "shunt patient in a persistent vegetative state." CIGNA seized upon this language and began pressuring Steve to have her put on Medicaid.
"I had to wait for weeks to get the chief of therapy to do a real evaluation of her, so they could see that she wasn't vegetative, so they could see her respond to commands and react to music and other stimulation."
And that became the wall Steve had to scale again and again: CIGNA said Marian would never recover, couldn’t progress; they wanted Marian placed in a custodial facility, where she would be maintained at a minimal level, but not treated in any meaningful way. There would be no future for them as a family, or for Marian as a mother and a wife. To the insurance company, Marian was no more than an empty shell with nothing to gain and nothing to contribute. But Steve knew better.
He fought for her to be sent to the Rehabilitation Institute of Chicago – a premier brain-injury facility. Based on RIC’s determination that Marian needed intensive inpatient rehabilitation, CIGNA approved the transfer and Steve flew with Marian to Illinois.
Weeks later, RIC doctors said she couldn’t continue her progress without major surgery to excise a bedsore (which kept her from participating in physical therapy). They transferred her to Northwestern Memorial Hospital in Chicago, where she had the wound removed, then underwent a second operation to close the wound, as well as two surgeries to try to restore her vision, which would allow for further improvement in her occupational therapy.
As Marian struggled to overcome the effects of so much surgery, CIGNA declared she wasn’t making sufficient progress. They wanted to ship her to a nursing home, where she would receive only custodial care. No physical therapy. No occupational therapy. No speech therapy.
“She has to have the chance to recover as much as she can,’’ Steve said. “They just want to write her off and wait for her to die.”
CIGNA officials flatly refused to approve Marian’s return to the rehabilitation center, insisting they would only pay for nursing home care.
“No,’’ Steve said, “I’m not going to allow that.”
Because Steve is Marian's legal guardian, the hospital where she underwent her surgeries could not discharge her without his approval. And hospital officials couldn’t transfer her to a nursing home unless Steve gave his okay. Which he refused to do.
Through October, November, December, January, February, March, Marian remained at the acute care hospital with sporadic and very limited therapy.
Juggling job demands, kids needs, Marian's heart
At the beginning of this Chicago ordeal, Steve and Marian's children, Chloe and Grant, were staying with relatives in Oklahoma. In December, Steve brought them to Chicago so they could have Christmas with their mom. The day before Christmas Eve, hospital officials told Steve he had to get Marian out of there. They could no longer care for her because CIGNA was cutting their reimbursement. Steve stuck to his guns, refusing to approve a discharge. They were not going to dump his wife into a place of no progress and no return.
Meanwhile, Steve had to get back to Florida, had to put the children back in school and day care and had to return to work at the newspaper. He is his family's only source of support and they were financially devastated by Marian's continuing illness, his daily war to save her and his family's scattered existence.
He was also Marian’s only hope of recovery, her daily therapy partner, her companion and constant supporter. It was his voice, his touch, his words of comfort and encouragement that kept her struggling to get better. Now they would be thousands of miles apart.
When he returned to Florida, Steve fought to keep his career afloat, his household running and his children content. Every single day, while he was at work, he got a telephone call from a committee at Marian’s hospital, pressuring him to approve her discharge. CIGNA had reduced the hospital’s reimbursement rate to that of a nursing home – a cut that cost the hospital thousands of dollars every week she was there.
Marian was on the medical/surgical floor – an expensive unit. It was full. And she was taking up space without bringing in enough money to pay for her care. Steve wouldn’t budge. He would not allow her to be warehoused in a nursing home, with no hope for improvement.
“What kind of outcome do you expect?” the hospital’s committee members demanded.
“I can see her learning to use a motorized wheelchair,” Steve said. “I can see her learning how to talk again, so she could be part of our family in a real way.”
In fact, Marian WAS learning to talk again. And, thanks to the surgeries, she had regained partial vision in one eye. Every therapist who saw Marian at the hospital recommended her return to an inpatient rehabilitation center – RIC – for intensive therapy. In all, more than 25 medical professionals, doctors and therapists who were specialists in their fields, examined and treated Marian and recognized her need for acute inpatient therapy.
But Cigna's hired doctor, who never laid eyes on Marian, never talked to her, examined her or treated her, determined such therapy was not medically necessary.
Denied, said CIGNA. Denied. Denied. Denied.
The company contacted Marian’s hospital: Starting in February, CIGNA would pay NOTHING for Marian’s care. Nothing to the hospital. Nothing to a nursing home. Everything was off the table. It was as if Cigna officials were trying to show Steve who was really in charge. If they couldn't get him to accept limited care, then they'd refuse her any care at all.
In March, Steve flew to Chicago and met with the hospital committee, yet again. This time, the doctors from RIC attended the meeting. Steve begged for Marian to get SOME kind of intensive therapy.
The hospital made an offer: They would keep Marian for a few more weeks at no charge, while she got enough aggressive therapy to prepare her for discharge home. There, Steve hoped, she could get in-home nursing and therapy services and, finally, be with her family again.
Stranded in a Rural Subdivision
That’s partly what happened. Marian did receive several weeks of therapy and was discharged April 10. The Chicago doctors ordered her to have physical, speech and occupational therapies in Florida. So Marian was sent home.
But CIGNA hadn't finished with Marian and Steve. CIGNA's doctors "reevaluated" her and determined that Marian wasn’t making – couldn’t make – sufficient progress to warrant all the recommended therapies. CIGNA’s doctors are employed by the insurance company. They never saw her. They never treated her. They just made a determination to get the insurance company out of the messy business of paying for the care she needed.
They authorized only limited occupational therapy at home. No home nursing care. Inadequate equipment to help Steve move Marian from the bed to wheelchair or treadmill. She had only an old standard wheelchair, when the doctors insisted she needed a custom chair because of her unique physical condition.
So there was Steve, back on unpaid leave from his job, trying to take care of Marian at home with no help. He had no one to watch her while he took the children to school and day care. When Chloe became sick with a spiking fever, Steve had to call a medical transport company to take Marian and the whole family to the pediatrician’s office so his little girl could be treated.
He can’t go back to work now. Marian can’t be left alone and CIGNA won’t pay for in-home care.
Each morning, Steve has to gamble – rushing the children to school, barreling through the grocery store for the day’s supplies and bolting home, praying all the while that nothing has happened to Marian in his absence. He is trying to keep his family together and happy and to meet everyone's needs, but he's drowning.
He has hired an attorney to fight CIGNA’s refusal to pay for intensive therapy, but it’s an agonizingly slow, arduous process of seeking medical documentation, waiting for hospitals, doctors and CIGNA to reply to requests for records.
But, amazingly, in all of this, Marian IS making progress. Her vocabulary is growing and her interaction with Steve and the children gives hope to them all. By using a lift he bought with his own money, Steve was able to get Marian on a treadmill to begin moving and exercising her legs. He is trying to enroll her in a University of South Florida speech therapy program. But he’s running out of money and time and options.
We all know, and experts who have seen Marian, evaluated her and treated her agree, that Marian can make a tremendous recovery. That she can be a participant in her family and a mother to her children. The single impediment to her recovery has been the insurance that she and Steve paid for, for years, and then had the nerve to rely upon when it was time for them to use the coverage they had purchased.
Right now, Steve spends every night sleeping in a chair next to Marian's bed, holding her hand through the silent hours, taking care of her personal and medical needs. He tries to keep the children occupied and entertained, but this lively family that once went on great excursions together, now goes nowhere.
As their lives become ever more limited, Steve has watched his children retreat into a sadness he is powerless to soothe. He can't continue to meet Marian’s needs. He can't spare his children the anguish of watching his struggle and witnessing their mother's painful efforts to overcome this cataclysmic injury. The daily tasks of caring for the family are more than any one person can manage. Although the Times has extended his leave, Steve is fearful that at some point, in this stressed economy, the Times will have to cut him loose.
The only thing that can change all of this is money. It all seems so overwhelming, but if every person who read this story gave some small bit, this is a family we can save.
We, Steve's friends, have opened a trust account for his family. The account is intended to provide Marian with the various therapies she needs to recover, to pay for the medical equipment and in-home assistance Steve needs to keep her healthy and help her improve and to manage the basic needs of his family.
Please, PLEASE, help us, Steve's friends, to save his family.
Please go to the upper right hand corner of this blog to make a donation in any amount, via Paypal.
You can also make a check out to "Marian Coddington Trust" and send to:
Attention Special Handling VA-RIC-9292
P.O. Box 27572
Richmond, VA 23261
And when you have made your donation, please tell everyone you know to read Steve and Marian's story and ask them to make a contribution as well.
We are deeply grateful for all of your generosity. Thank you.
Wherever possible, throughout this story, we have provided links to verify the information we are giving, but if you have any questions to ask before you feel comfortable making a contribution, please feel free to direct inquiries to firstname.lastname@example.org.