Cost of being underinsured: His right arm
Local News Philadelphia & the Region
1/17/08 By: Daniel Rubin

Eric Simpson was strangely calm when the insurance company called last week, saying it was sending a man for his right arm. The woman on the phone told him he should have known he had only $2,000 of coverage through Aetna for artificial limbs. And the arm, which he's just received that week, cost more like $37,000. But, he protested, he's been preapproved.

Angelo Russello had the job of taking Simpson's arm. He works for Allied Orthotics & Prosthetics in Northeast Philadelphia. All week he'd been visiting Simpson at Moss Rehab in Elkins Park, fitting the device, teaching the 32-year-old Germantown man how to flex his muscles to move the thumb and fingers. "I felt like a fool," says Russello. "I've got to tell you, this has never happened before." Simpson read his face and said, "Just take it." Eric Simpson is growing used to being disarmed.

Lost in a fall

The first time was back in 1996, when he was 21. He was riding an all-terrain vehicle near Belmont Plateau when he lost control and was thrown 30 feet. He came to in his cousin's arms. "Why are you crying?" asked Simpson, a strapping former high school basketball player. He didn't realize the fall had severed some nerves. From that day his arm began withering.

The second time was April 2007. By now he was making a living in a rough stretch of Germantown. He owned a cell-phone store and a building across The Avenue with a soul food restaurant downstairs and a recording studio upstairs. He carried a gun, he says, for protection.

Insurance

"It's like you got to have one here. There are guys 15, 16 years old. They're kids. They're just running around with no sense of direction. What do we do?" If we're a convicted felon, we don't carry a gun, his lawyer, Dennis Cogan, told him. Simpson had to give up his Glock.

Cogan remembers the words Simpson used: "You want me to disarm unilaterally?"

Cogan did. Simpson wasn't permitted to carry because he'd been convicted of receiving stolen property. He says a friend told him she had a $6,000 credit at Home Depot and that he could pick up things there cheap. He gave her an order, and police arrested him at the store. "I'm not saying he has an angel's background," Cogan says of his client, "but he's a nice guy."

Simpson was defenseless early one night in June when he and some friends were walking back to his shop. A black Tahoe SUV pulled up and a masked gunman jumped out. Everyone scattered but Simpson stumbled. The gunman fired seven bullets into the dead arm. A message? Maybe, Simpson says, but he doesn't know who from or what about. No arrest was made.

Gone for Good

The third time was no charm. The last day of August, doctors had to amputate the arm, which was not healing. Simpson says he'd become resigned to losing it. He'd learned to write with his left hand, throw a football. Doctors told him that artificial arms would let him do amazing things. In October, he went to Allied, and was told his $530 monthly premiums entitled him to a prosthetic. It would be ready in a couple of months.

But not before he was shot again. One December day he was walking out of his house when he was struck. Someone had fired from way up The Avenue. This time, a bullet lodged in Simpson's spine. Since then he's been partially paralyzed. He uses a wheelchair to get around Moss.

Which is where the reluctant Russello found him on January 10. The prosthetician removed the Velcro strap from around Simpson's chest and tugged the artificial limb from the stump of his upper arm. "It was bizarre," Simpson says. He started making phone calls - to his girlfriend, to an aunt, to his lawyer. Allied called Aetna for him.

He wheeled himself down to the nurse's station, where someone hollered. "Eric, what happened to your arm? Did you leave it in your room?" "A long story," he replied. He explained there was a problem with insurance. "A miscommunication," Aetna spokesman Walt Cherniak said yesterday.

Aetna officials had mistakenly considered his new arm medical equipment rather than a prosthetic, which is covered in full. They called Simpson to apologize. And the next day, Friday, Russello returned the arm.

"Honestly, I didn't think it would be back so soon," Simpson said Tuesday in his room. The new arm will make it easier to dress himself, to support his weight, as he tries to recover from his spinal injury. Doctors give him hope he'll walk again. As we spoke, it was hard to hear the man in the next bed talking with a rehab specialist. "The wife just gave me the bad news," he said. "The insurance company just called and said we don't have approval for the procedure."

Sounds like it's going around.