She kept her head as insurance sorted out skull surgery

MIDVALE, Utah - After waiting longer than anyone would want to, Briana Lane has her skull back in one piece.

The 22-year-old woman was injured in an auto accident in January, and doctors temporarily removed nearly half her skull to save her life.

But for nearly four months afterward, the piece of bone lay in a hospital freezer across town - and Lane had to wear a plastic street hockey helmet - because of a standoff with Medicaid and the hospital over who would cover the surgery to make her whole again.

The surgery finally happened after an excruciating wait, during which she suffered pain just bending down and would wake up to find that her brain had shifted to one side during the night.

"When you think of weird things happening to people you don't think of that," Lane said. "It's like taking out someone's heart - you need that!"

Sonya Schwartz, a health policy analyst for a consumer health care group, said insurance horror stories happen every day. But "this particular story is outlandish."

On Jan. 10, Lane's car rolled over on an icy canyon road above Salt Lake City. Lane was thrown through the windshield. She was later charged with driving under the influence and not having a driver's license.

Doctors at the University of Utah Health Sciences Center in Salt Lake City removed the left side of her skull to treat bleeding on her brain. Lane's doctor scheduled the replacement surgery for mid March, a month after her release from the hospital, said her mother, Margaret McKinney.

But the operation was canceled the night before because the hospital was waiting to see if Medicaid would cover it - a process that can take at least 90 days.

Lane, a waitress with no insurance, was sent home from the hospital with a big dent in her head where the bone had been removed but the scalp had been sewn back into place. She stayed at home, able to walk around but not go to work, and had to wear the helmet during the day.

During the wait for a decision from Medicaid, the hospital could have declared an emergency, moved ahead with the surgery, and figured out afterward who would pay - the hospital, Medicaid, or the patient. But the hospital did not do so.

Lane's mother said that she argued with the hospital: "We just want what you've taken away. Can you just give us back the skull and we'll go on with our lives?"

After months of delay, Lane contacted a TV station, a move she believes hastened the surgery. "All of a sudden - top of the list!" she said. The operation took place April 30.

What broke the impasse is unclear.

The operation took place after Lane's mother's insurance decided to cover the surgery, as well as her nearly $200,000 in medical bills.

But hospital spokeswoman Anne Brillinger, while refusing to comment on certain specifics of Lane's case because of federal privacy rules, said the medical center decided to go forward with the surgery before it learned the insurance would pay.

Utah's Medicaid program has yet to decide whether Lane qualifies.

Robert Knudson, director of eligibility services at the Utah Health Department, which oversees Medicaid, said the agency has not yet seen enough evidence to decide whether her injuries entitle her to benefits under the law.

He would not comment on whether her wait was unreasonable. But he said the decision over how fast Lane should have gotten treatment was up to the doctors, not Medicaid. "We only pay the bills," he said.

World and national headlines

© 2006 • All Rights Reserved • Tampa Bay Times 490 First Avenue South • St. Petersburg, FL 33701 • 727-893-8111 Contact the Times | Privacy Policy Standard of Accuracy | Terms, Conditions & Copyright