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David Ragan - Sppedco
David Ragan - Sppedco

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More of David on youTube

Shriners Success Stories

- Peter

Peter burned his hands on Tuesday December 1st. He lost his balance and caught himself on the glass screen of our gas fireplace. His hands were swollen, blistered and he was crying inconsolably.  We immediately took him to Children’s Healthcare of Atlanta Urgent Care in Forsyth County.  Their initial assessment was it was second degree burns and they treated it with Silver Sulfadiazine Cream. They gave him a shot of morphine to help with the initial pain and referred us to Joseph M Still Burn Center in Austell for an appointment the next day.
We took Peter to JMS burn center the next day. They took our insurance information. Once they called us back to the exam room the nurse interviewed to see what happened and unwrapped the initial wrappings put on Peter’s hands.   The doctor flipped his hands over and told us they needed to schedule surgery immediately. The doctor did not do any further examination other than just a glance at Peter’s blistered hands.   The nurse or doctor did not wipe off the area prior to their review so it still had residue from the past days’ treatment.   Looking back after the care we received at Shriners it is impossible to understand how the doctor came to that result under those circumstances.  Because Peter was on some fairly heavy pain killers it was important to Rachel that he eat, in accordance with the instruction on the medicine bottle. This action went against the instructions on the paper given to us in the Urgent care center. The paper stated that you should not eat 8 hours before your appointment.   The doctor scolded Rachel for giving Peter a bottle prior to the appointment because he wanted to do immediate surgery.  The doctor then requested that surgery be scheduled for Thursday December 3rd.   He said it was important that we scheduled the surgery within 48 hours (definitely before the weekend) because there was a risk of scarring and nerve damage if it wasn’t done by then.  They scheduled cadaver skin graft surgery for 6 am the next morning. They quickly  re-wrapped his hands without cleansing the area and they began taping the bandages to his arm stating it didn’t matter that it would hurt to pull them off because he would be under anesthesia when they took them off.
On the way home from the hospital the doctor’s office called and stated they were not in our insurance network, and that they would not accept any HMO plans off of the healthcare marketplace. The woman from the office also said that there most likely aren’t many other options because they were one of the only burn centers in Georgia.   Rachel asked what the surgery would cost if we were to pay for the surgery out of pocket and they stated that they  couldn’t tell me exactly the cost of the surgery but that they would typically bill the insurance $60,000 for this particular surgery. They also stated that it appeared a second surgery would be necessary which would be another $30,000. The office said it would be possible that it would be cheaper to do it out of pocket but they were unable to give us a specific figure.   They stated that they usually offered payment plans for people who are unable to pay the whole amount upfront. We stated we would call our insurance to see if there is anything we could do to work it out with them.

When we called Coventry they stated we needed to find a doctor in network that performed the same services. They gave us a doctor to call but when we called that doctor they were no longer working in Georgia and they were just a general pediatrician.   After multiple calls, CoventryOne staff could not find a Doctor that treated pediatric burns in Georgia, on their list of network providers. Despite my request to speak with upper management, I was bounced from person to person, repeating our story and getting no real help!  We called the insurance company back to see what else we could do and they stated we needed to fill out an out of network authorization form. The insurance company stated that if there were any other doctor in network in the state of Georgia that offered the services we needed then they would refuse to pay anything towards the surgery.   We had to call back several times to get the exact title of the doctor so we could see if we could find any providers that could help within that 48 hour time frame we were given by the doctor.
Coventry closed at 5 pm and they did not have any one working outside of that time frame to continue to help us. We therefore had to decide whether to go forward with the surgery and risk insurance not covering any of the amounts or delay the surgery. We spent all night going through the Coventry website trying to figure out the doctors that are in network for our insurance plan. We also contacted a close family friend to ask about the Shriners hospital to see if that could possibly be an option.   We called a contact with Shriners at 9 pm to see what our options could be with that but we didn’t end up hearing from him until late the next morning. We decided to move forward with the surgery because we were told by the doctor that it was imperative to do it immediately.
Rachel was so concerned about the surgery that she did not sleep at all Wednesday night. She continued to research the in-network doctors and also treatment of second degree burns. In her research she also saw that most second degree burns rarely actually require skin graft surgery.    At 3 AM she was concerned that surgery was not the right option and she decided to call Shriners Hospital in Cincinnati, OH directly to see if they could be of any assistance.   She was immediately impressed in the fact that they had someone who answered and they just told her to come on and they would have a room for us when we got there. We packed up a suitcase and left our house at 3:30 AM. I left multiple messages on the voicemails of contacts at the JMS Burn Center – informing them of our decision to go to Shriners Hospital in Cincinatti, and to cancel the surgery at JMS Burn Center, and despite those messages, they called as we were driving, asking us if we were going to show up for surgery. 

We got to the Shriners Hospital in Cincinnati, Ohio around 1:30 PM on Thursday. As soon as we got there a staff member met with us in the lobby to give us an idea of how everything would go in our appointment. They let us know they were going to cut back the blistered dead skin (debride) to see how the skin looked underneath it.   The staff cut back the dead skin and immediately said it did not appear Peter would need surgery. We received opinions from 3 separate staff members who came to the same conclusion. Shriner’s hospitals believe in a “watch and wait” approach and told us they wanted to see us in 12 days. They instructed us to change his bandages twice a day.   They showed us how to wrap the wounds and let us know they would see us in the morning to make sure we were comfortable in putting on the bandages. The hospital also gave us all of the supplies we needed to care for the wounds.
The assessment at Shriners was in direct contrast to the assessment at JMS Burn Center. There were several alarming differences;
·        The JMS made us feel that immediate surgery was needed to protect the safety of our son, but the Shriner’s hospital stated that burns are not at their worst until 48 hours after the burn occurs, and that you can’t make a decision of treatment until that time.
·        At Shriners, instead of debriding the skin under anesthesia, they distracted Peter  with toys, bubbles and an ipad, which did not take away the pain of this important procedure, but did avoid anesthesia for this 11 month old.
·        The JMS Burn Center instructed us to use Childrens’Motrin for pain management, but Shriners Hospital instructed us NOT to use Motrin because of its blood-thinning effect, especially if surgery might be needed.
·        Shriners stated that use of the Silver Sulfadiazine is not appropriate treatment for 2nd degree burns, and that the wounds could not be accurately visualized, as the cream can sometimes stain the tissue.
Obviously, this unfortunate accidental injury was very traumatic for our son Peter, as well as for us, his parents. We felt we were being urged to make rapid decisions, knowing that we risk a $60-90,000 hospital bill, that would bankrupt our family, and we were ready to do whatever was needed for the wellbeing of our son.  Something did not feel “right and just”. We are paying monthly for CoventryOne  insurance and were receiving no help from them in this critical situation…. “Sorry we close at 5:00”. We have had no follow-up from CoventryOne,  and are wondering, even  if  they approved the “out of network” evaluation at JMS, will JMS accept their payment.   Will Coventry cover the bill at Shriners as well, since there was no alternative in Atlanta.?
We were transported back to Cincinatti by the Shriners on Dec 11th , Peter was re-evaluated and we were instructed on further wound care. He was seen again on Dec 21st, where they removed his bandages, and he was healing well, requiring massage for scar prevention. We feel so thankful for the wonderful care at Shriners. 

We’ve always had faith in our medical system, trusting that care will be provided when needed. What happened in reality was such a jarring shock, and we hope this will never happen to others, who work hard to pay for their healthcare coverage, only to have it rejected by the  private, for- profit  burn center that we were refer to by Children’s Health Care of Atlanta.


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