Life, Love and an Insurance Denial

May 27, 2022 | Blog

A Life Story GEM

Bill and Marjorie smiling and eating food

Meet Bill and Marjorie Johnston. (Enjoying a wonderful celebration at Palm Garden) You’d never guess Bill has made 102 trips around the Sun!

He and Marjorie recently celebrated their 34th wedding anniversary. They didn’t go out to celebrate. In fact, they haven’t been to a restaurant in over 2 years- staying home since covid. Pretty much Bill just shoots over to Publix because it’s only two turns from their house. “Marjorie worries about me driving and all the kids are up north.”

A couple of weeks ago Marjorie was hospitalized with a fall, a large skin tear to her left forearm, and some fractures. She was admitted for her inability to ambulate. Marjorie is the sole caregiver of her 102-year-old husband. When we met them they were sharing a room at Morton Plant Hospital. Bill was hospitalized due to his sudden inability to care for himself.

They share such a rich life story. Ask Marjorie where she and Bill met and she’ll tell you “we met at Morton Plant Hospital, third floor, I was his wife’s nurse.”

Bill and Marjorie met because Marjorie was Bill’s first wife’s nurse at Morton Plant Hospital. Bill’s wife had terminal cancer. She was a lovely lady that became friends with Marjorie during her lengthy hospitalization. When she discharged, Marjorie would occasionally go to dinner with the Johnstons. It was at one of these dinners that Mrs. Johnston pulled Marjorie aside and said “promise me, when I go you will check on Bill. I’m just so worried what will happen to him, he’s never been alone.”

Months later Bill’s wife passed.

True to her promise and despite her own health obstacles, Marjorie called Bill. They developed a friendship. And when it came time for Marjorie to have a procedure to remove a mass, Bill drove her to the hospital. He stayed with her until she was stable. Then he’d frequently check up on her. Their relationship blossomed and they married 5 years later.

That was 34 years ago.

The dinner you see in the picture wasn’t just to celebrate 34 years of marriage! It was also to celebrate them being together at Palm Garden.

You see, insurance approved Marjorie’s post-acute rehabilitation at Palm Garden, but not Bill’s. Not after numerous calls from medical experts at the hospital. Not even after a peer-to-peer review with a physician. Insurance denied prior authorization. Still, the fact remained, Bill couldn’t be home by himself. He needed Marjorie with him. He was in the hospital because he couldn’t care for himself at home!

Marjorie was in tears; she couldn’t have Bill go home or to any other SNF. It had to be Palm Garden. Lisa Kent, our Regional Director of Transitional Services reassured Marjorie “it’s going to be ok, we’ll work it out. This isn’t going to happen on our watch.” She explained all the options and said “listen, our Mission is to enrich the lives of those we serve. We’re not going to let Bill go home alone.” Lisa made a phone call.

Nick Neubauer, our incredible Director of Guest Services, and Barbara Grow, our tenacious Director of Rehabilitative Services at Palm Garden sprang into action and combed through the medical evidence. They made a compelling appeal for insurance authorization based on the information Lisa provided.

Guess what? GOT AUTH! Mr. and Mrs. Johnston were so excited when we gave them the news.

That beautiful meal and those wonderful smiles? A celebration feast (in more ways than one) from Palm Garden for our dear family members Bill and Marjorie.

This is what Palm Garden is all about. Going the Extra Mile to Celebrate Life Stories. And it is our pleasure.