On Nov. 4, Alicia Messinger was strong enough to return home from the hospital, but a month later, she’s still waiting for the day it actually happens.
STOCKTON, CA — A bout with pneumonia on Oct. 11 put 25-year-old Alicia Messinger of Stockton in the respiratory intensive care unit of St. Joseph’s Medical Center.
By Nov. 4, her doctor declared her strong enough to go home as long as she slept with a nocturnal ventilator to keep oxygen flowing into her lungs.
Following more than three weeks in the hospital, Messinger was thrilled to be going home. After all, she and her husband of a little more than a year, Adam, had just bought a house the month before, and she was eager to continue settling in.
Her elation quickly turned to confusion, frustration and anger when Messinger realized there was a problem with her health insurance.
A home ventilator, considered durable medical equipment, can cost up to $40,000. Renting one, along with the necessary supplies, can run $3,000 to $4,000 a month. Messinger’s insurance policy caps coverage of durable medical equipment at $2,500 a year, a common practice among all health plans. So her request for a home ventilator was denied.
But the insurance company would pay the $9,176 a day it cost to stay in the hospital.
"I feel like a hostage," Messinger said three weeks after her discharge came through and she was still in the hospital.
"At the end of every dead-end conversation that I have had in the last several weeks, my last tear-filled statement is always the same: ‘I just want to go home,’ " Messinger wrote in an e-mail to The Record.
On Nov. 26 – the day before Thanksgiving – her insurance company, UnitedHealthcare, finally made an exception and removed the maximum spending cap for durable medical equipment from Messinger’s health policy. But not before it had racked up well over $200,000 in additional charges for her hospitalization.
Messinger said before Thanksgiving her charges at St. Joseph’s were more than $500,000, of which UnitedHealthcare would be billed more than $300,000. That bill is much higher today and will continue to grow until Messinger finally goes home, possibly at the end of next week. She said she will only have to pay $2,500, and she is grateful her insurer is paying for the bulk of her care.
"I’ve dealt with these situations before with the medical directors of various health plans," said Messinger’s physician, Dr. Ronald Kass, a Stockton pulmonologist and sleep-disorders specialist.
"The problem is a lot of these insurance companies don’t have policies for home ventilators, but they need to modernize their policies. Most people would rather be at home than in a subacute unit for the rest of their lives, which is a lot more expensive," Kass said.
Kass, a graduate of the University of California, San Francisco, School of Medicine who’s practiced in San Joaquin County for 23 years, said Messinger can be maintained at home for the next five years just for what it has already cost her insurance company in avoidable charges.
Anthony Wright, executive director of Health Access California and a longtime advocate for quality, affordable health care, described Messinger’s experience with her insurer as "penny-wise and pound-foolish. Insurance companies, for as much as they sometimes deny people coverage to increase their bottom line, they sometimes make bad decisions that also hurt their bottom line. This is ironic."
Jerry Flanagan with Consumer Watchdog, a frequent critic of California health-insurance company practices, said upon learning about Messinger’s case that she was the victim of "legions of bean counters that deal with voluminous rules to prevent individuals from getting care.
"There is no incentive to be efficient and provide quality service. There is no incentive that makes the insurance company strive for efficiency, so the needs of the individual patients get lost," Flanagan said.
St. Joseph’s assigned Andrea Kerr, a 10-year veteran social worker, to work with Messinger and her family on her discharge planning. She initially contacted UnitedHealthcare about Messinger’s prescription for a home ventilator.
"I’ve never had a case like this where the patient is stable to go home and not been able to go home. Stuck in an intensive care unit, that is not the norm. It just did not make sense on the insurance end not to budge a little bit," Kerr said.
"It shows just how messed up the health care system can be."
By way of explaining the delay, UnitedHealthcare spokeswoman Cheryl Randolph said company records show it was first contacted about the need for a home ventilator Nov. 13, more than a week after Messinger was given her discharge. No one could explain the discrepancy in dates.
As for why it took as long as it did to remove the maximum $2,500 cap on coverage, Randolph said, "You actually want to be careful in this. Family members need to be trained. She obviously has a condition that requires a lot of care.
"I understand (Messinger’s position): Who wants to be in the hospital? We were making sure that everything was set up. … It’s not like we wanted to prevent her from going home."
Disabled since birth, Messinger, a 2002 graduate of Manteca’s Sierra High School – where she was known as Alicia Mellinger – has not been a stranger to doctors and hospitals. But that hasn’t stopped her from pursuing an independent life, including landing a job – with full benefits – with United Cerebral Palsy, where she assists other disabled adults in getting jobs.
In fact, she believes it was her determination not to miss a day of work even though she was suffering from a respiratory ailment that put her in the hospital in the first place.
As a woman of faith, Messinger has been assisted by a network of people that goes far beyond her supportive family and the health care professionals who saved her life at St. Joseph’s.
"I believe that Jesus has been here throughout this whole thing with me. Support has come from people around the country praying for me," she said. She noted that six days before UnitedHealthcare granted her an exception, a dozen or so members of her church, New Day Community Church of Stockton, spent an hour each in a continuous vigil praying
with her in her hospital room.
Registered nurse Dana Orellana, who has gotten to know Messinger during her two-month stay in the hospital, said "she is an inspiration to all of us. She has advocated for herself all along. The only thing that gets her down is she can’t go home yet."
Contact reporter Joe Goldeen at (209) 239-6606 or [email protected].
