A Happy Reversal of Policy

Philomena Rogers's daughter, Shelby, requires 12 hours a day of private duty nursing care.
Philomena Rogers's daughter, Shelby, requires 12 hours a day of private duty nursing care. (By Lois Raimondo -- The Washington Post)
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By Joe Davidson
Friday, February 6, 2009

It's nice to report good news now and then.

Remember Shelby Rogers? She's the cute 12-year-old Arlington girl who needs overnight nursing care because a muscular disease leaves her so weak that she can't take care of her basic needs, including breathing.

We wrote about her in November. Then the news wasn't good.

Her parents, Philomena (everyone calls her Phil) and John Rogers, were livid because they had been told their Aetna health insurance policy, which John has through the Commodity Futures Trading Commission, planned to stop Shelby's 12 hours of daily private duty nursing care.

But now the Rogerses are celebrating word from Aetna that it has approved care for her through the end of the year.

"Shelby will continue to be eligible for up to 12 hours of skilled nursing services per day, 7 days per week through the balance of 2009," says a Jan. 14 letter from Christopher L. Weinrich, Aetna's director of federal operations.

What happens next year remains to be seen.

"It's impossible to sit here in February and say anything about 2010," said Aetna spokesman Walt Cherniak. Federal health insurance coverage is determined by the insurance companies in cooperation with the Office of Personnel Management through a process that begins in May of each year and continues until September.

"It's simply too early for us to talk about what our plans will look like," Cherniak added.

If those plans change and Shelby is deemed ineligible for the overnight services, "then we're screwed," Phil said.

For now, Shelby and her parents are pleased with Aetna's decision to provide the care she needs. The latest letter is a big relief because a few days before Christmas, a letter from the OPM said that "unless Shelby's condition changes, it does not appear that she should be able to use the 2009 Home Health Services benefit to meet her needs."

The OPM then reversed itself and said in a subsequent communication that "the letter should have stated that it does appear that Shelby will be able to use the benefit."

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