Man wakes from coma to lack of health benefits - Dallas News | myFOXdfw.com

Man wakes from coma to lack of health benefits

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CHICAGO (FOX 32 News) -

A west suburban man who spent more than two months in a coma eventually woke up, only to find his health benefits in jeopardy.

His family blames his union's health plan. The union says it was all a misunderstanding.

This is the story of a devastating injury to a dedicated construction worker, who helped on projects ranging from U.S. Cellular Field to the Rush Medical Center.

His family says his union's health plan should be equally dedicated to his recovery.

Carl Carozza can barely speak and can't walk, but he's doing better now than last September, when a motorcycle accident left the forty-four-year old from Woodale with a broken neck and brain injuries.

He was in a coma for two and half months.

"There was no hope they were giving to the family. they were just telling us there's no hope whatsoever," David Carozza, Carl's brother, said.

In mid-November, when Carl woke up from the coma, he entered the Rehabilitation Institute of Chicago, and showed remarkable resilience.

"He's been making tremendous progress.to the point now where now he's talking laughing joking, talking about the past," David said.

"He's just progressing, his strength is coming back, he's sharp, his mind's coming back," Keri McGuire, Carl's girlfriend, said.

Carl's family expected the Laborers Union Pension and Welfare Fund to cover the medical bills, which have totaled around three quarters of a million dollars.

But as Carl was preparing to move to a residential rehab setting, his coverage was suddenly suspended.

The services he was receiving like help with eating or brushing his teeth, were described to him as "primarily custodial in nature," and the plan only covered services which would improve a patient's condition.

Carl's father was shocked.

"Since Carl's been there, he's always promoted the union, He's always big on unions. Even on his vehicle, he always had a bumper sticker saying "support the union. " So I don't' understand their reluctance to pay," Ralph Carozza, Carl's father, said.

A few days after we contacted health fund officials, however, the health plan reversed its decision.

The administrator says that an initial evaluation of Carl's new residential setting mistakenly suggested he would receive only custodial care. When officials learned otherwise, the benefits were reinstated, although they'll be reviewed monthly to see if Carl is improving.

Carl's family is pleased the coverage will continue, but remains skeptical of the union's commitment to Carl's recovery.

"You know, don't' trust that the union's going to be there for you when something like this happens," David said.

By the way, the health plan's refusal to cover mere custodial services isn't unusual.

FOX 32's Larry Yellen looked at several plans and found that in cases like these, the benefits get paid as long as the patient is making some progress. If the progress stops and the patient starts slipping downhill, the benefits will be discontinued.

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