Michael Stanzione got into a hospital, but he can't get out.
Insurance woes have kept Stanzione cooped up in a hospital for three years, the Bergen Record reports. But it's not like he's bedridden. In fact, he walks short distances and can sit for hours working on his computer. He sometimes throws a ball to his son during visits.
Stanzione has Pompe disease, a rare illness that has so seriously compromised the muscles around his lungs that he can't breathe deeply enough to take in the air he needs. Ideally, he would live at his Saddle Brook, N.J., home with full-time nursing care to ensure that his ventilator is working and come help him if he chokes.
But he can't.
"It's the stupidity of insurance that's keeping him in the hospital," Dr. Steven Jacoby, a pulmonologist who oversees Stanzione's care, told the Record.
For now, Stanzione calls Bergen Regional Medical Center home, because insurance won't pay for home healthcare.
Institutional Medicaid covers his care at Bergen Regional, but it doesn't cover outside services. Standard Medicaid coverage offers home services, but Stanzione's disability income disqualifies him for that. Aetna covers the family through his wife's employer, but pays nothing for his hospitalization, because the family is covered through Institutional Medicaid.
It would be cheaper for the system to send him home, Jacoby said. But Aetna would cover only 60 four-hour visits a year, an Aetna spokeperson told the Record. Medicare could fund some part-time care, but the patient's social worker said she has never seen Medicare approve more than four hours on weekdays.
Stanzione is now hoping for a Medicaid waiver, but is afraid his disability payments will disqualify him. "After that," his wife Debra said, "we don't have a Plan B."
To learn more:
- check out the Bergen Record story