Insurance companies told enrollees that COVID-19 was covered, but experts say that promise has its limits
ST. LOUIS COUNTY, Mo. — Gerald and Lakeitha Adory met 11 years ago working the jobs that would put them directly in the path of a global pandemic.
They were both nurses in the same St. Louis County nursing home.
“He asked me out one day and I said, ‘OK,’ but then I called later and turned him down,” Lakeitha remembered with a smile and laugh. “I don’t know why.”
“Then about six months after that, that’s when we went on our first date,” she said.
Last year they were working as licensed practical nurses in different facilities, with two young children at home, when COVID-19 arrived in St. Louis. They continued caring for the vulnerable both at work and off the clock.
In September, both Lakeitha and Gerald were diagnosed with COVID-19. Lakeitha’s symptoms were minimal. Gerald’s symptoms quickly became severe.
“He woke up that morning confused,” said Lakeitha. “He didn’t know who I was.” Gerald was slurring his speech, she remembered. “They had to basically sedate him. But then after that, he didn’t wake up.”
Gerald was in a coma for 38 days. He went through some of the worst symptoms known to come from COVID-19, and he miraculously survived.
“COVID affected him neurologically,” said Lakeitha. “It caused him to have blood clots in the brain and then a blood clot in the spine.”
Five months later, the aftermath of his COVID-19 diagnosis is that Gerald can’t walk, care for himself or care for his children. The Adorys said he was making progress in rehabilitation until their insurance company said they had reached the end of their coverage for it.
Lakeitha said his Anthem Blue Cross insurance will only cover 20 days of physical therapy for the entire year.
“Quite frankly, I really don’t think that’s enough,” she said. “We’re in the middle of a pandemic and, you know, he’s a nurse working the front lines and gets sick. And then now, you know, we have to fight and scrape for every little piece of therapy he can get.”
While they explore their options and adapt to Gerald’s limited mobility, the Adorys have gotten help from the community. One of the helpers is Steve Heerboth, who met Gerald at a nursing facility.
“I saw him care for my father the way he would care for his own father. That makes him like family,” said Heerboth. “I would see him provide the kind of care to others that he now needs. And so Lakeitha is essentially forced to run her own skilled nursing facility here.”
5 On Your Side reached out to Anthem Blue Cross Blue Shield for a statement. We will update this story when we receive it.
At the start of the pandemic, many insurance companies pledged to fully cover the costs of COVID-19 for their members, from covering testing costs to waiving cost-sharing for treatment. Caitlin Donovan, senior director of the Patient Advocate Foundation, said that broad promise has some unexpected limits.
“They may say, ‘You are officially recovered from COVID as soon as you’re released from the hospital.’ We’ve heard employee insurance say that once you can go back to work, that means you’re recovered,” Donovan said. “Other ones say that once you are no longer testing positive, anything from that point on, is a different condition.”
The medical profession is still learning about COVID-19 and its long-term effects. Studies show that around 10% of people diagnosed with COVID-19 have symptoms that last longer than three weeks. In some cases, the effects extend months after a positive test.
In April, researchers estimated that the additional medical costs for someone hospitalized for COVID-19 would average $4,000 over the year after they left the hospital.
A CDC report last year showed that 6% percent of hospitalized COVID-19 patients are healthcare professionals. Nurses were most represented in those cases, because they make up a large part of the healthcare workforce and they often see patients in close proximity and for the longest amount of time.
“He’s just the number to them, I believe. So he’s not, they don’t see him as a person or not individual,” said Lakeitha. “I think he deserves the kind of care that will get him back on his feet because his family needs it.”
Without more physical therapy, it’s unclear whether Gerald will ever go back to being the active husband, father and nurse he once was.
“Unfortunately we don’t cover therapy and rehab the way we should in this country, and that’s a big problem that needs a bigger solution,” said Donovan.
Despite losing so much, Gerald was able to express that he is still thankful.
“She’s the best thing that happened to me,” he said.
Resources that can help
Lakeitha plans to appeal the insurance company’s decision. The Patient Advocate Foundation has materials on their website to help patients learn about that process.
The Adory family just saw an increase in their insurance premiums for the year as well, Lakeitha says. They have a GoFundMe campaign, set up by Heerboth, which has raised more than $20,000 so far.
America’s Health Insurance Plans, a professional organization of health insurers, has a website dedicated to tracking insurers’ responses to the COVID-19 pandemic. You can check the page to see if your insurer has waived cost-sharing or made any other commitments to help with the cost of COVID-19 treatment.