Category Archives: Medicare

Well, I DID feel pretty……

Caregivers, Humor, Medicare, Uncategorized, , , ,

The beauty of blogging about caregiving is you get to ‘visit’ with those you have loved and cared for and lost.

I was thinking about my Aussie Aunt Jean this morning (probably because I got yet another bill for her that I had already dealt with four or five times by now ) and wanted to just spend some time thinking about our time together.

You may recall “A girl should be two things: Classy and Fabulous” Coco Chanel http://wp.me/p3CPfo-3i. That was my Aunt Jean. So we were never at a loss to do some girly thing while she was visiting. Shopping was her hobby and she rarely came home empty handed. All her purses matched her shoes, and she was never afraid of sparkle and bling all the way up to 90 years old.

But like many elders, her ‘aches and pains’ became a focus for her as much as her pretty outfits.

“Can I wear that black and white zebra print blouse with these horrible Sketchers?”

“Jeannie, the adorable zebra print looks great on you. The rest of your outfit matches, and you have to wear the Sketchers because your fashion boots are not stable enough, especially with the walker.”

“How about if I change my shoes in the car before we go into the restaurant?”

We weren’t meeting anyone at the restaurant, we were just going out shopping and for lunch.

“No, I don’t want you to fall. You still have to use your walker.”

“Fine,” she said, but in a very disappointed accent.

Then the shingles arrived, and that plagued her every day. So to get her out of her  shingles funk, I decided we would go get our nails done. By the way, she always had her nails done, this was not a treat for her, like it was for me. It was a necessity.

“Let’s go get our nails done!”

“Okay,” she said and with pretty much enthusiasm.

Off we go to the nail salon. My manicurists are delightful women. They treat my Mom, my Aunt and my daughters with kindness and interest. There’s lots of conversation and commenting like: “Ooohhh, that ‘s a pretty color! “My, you look so nice today.” “Are you going somewhere special with this mani-pedi?” That last comment for me because they know I don’t take time for this for just any occasion.

So there we were being all girly-girly getting French manicures and pedis and just relaxing and having a good time.

Two days later, Aunt Jean is still really uncomfortable with those damn shingles and one of her fingers on her left hand starts to blow up like a balloon.

We go back to the emergency clinic that diagnosed her shingles a few weeks ago, thinking that somehow the shingles moved to her finger?

The female doctor lances it, and works on it pretty hard so that Aunt Jean is wincing and yelping every once in a while.

“Well, Jean, nice manicure.”

“Thank you,” she says with an air of sophistication.

“But I think you got an infected finger from that nice manicure.”

See, I try to do something that will distract from those shingles and end up right back at the doctor.

“You just have to Laugh……………”

Cathy Sikorski

Go to Girl and Go Go Gadget

Caregivers, Humor, Medicare, Multiple Sclerosis, Uncategorized, , , , ,

Invariably, on the day you need to be in your car for 8 to 10 hours, that is the day, all hell will break loose.

My go-to Girl!
My go-to Girl!

My go-to girl is my amazing 85 year-old mom. Weird, for a caregiver, I know. But she is a former nurse and raised six kids, so she knows her stuff. She pours all the meds for my brother-in-law, she helps me out in every pinch and she loves going to the ER with me. So when she calls, I answer…immediately.

“Hello?”

“Cathy?”

“Yes, Mom,” I say on my handsfree car phone as I’m driving 65 miles an hour down the turnpike on my mission to hit as many major cities in the metropolitan area for various necessities on Easter weekend.

“Um, I’m at L’s apartment, and his wheelchair stopped dead. Can I release it and push it down the hallway to the dining room so he can go to dinner?”

“Wait, no, you can’t push it. You are 85 for crying out loud, that wheelchair weighs a thousand pounds without the big guy in it.” (See When Wine and Wheelchairs don’t mix….)

“Look, Mom, since he had the wheelchair fixed, there’s a button on the back that sometimes disengages his controls. Can you see the button on the back?”

“No, I can’t get behind him, he kind of stopped weirdly in the middle of his room, and I can’t get behind him.”

I can’t really figure that one out, but okay, I’ll work with what I’ve got here.

“Okay, can you stand on his right side and look behind his head area. That’s where the button is. See if it’s red or green.”

“Oh, ok, yes ok it’s green, wait, now it’s red.”

“It sounds like it’s cycling through. Just turn it off and then back on and then see if he can use his own controller. And stand far away, he’s been known to take off like a bat out of hell when we are trying to figure this out.”

“Oh…..okay.”

She fiddles with it a few times and it doesn’t seem to work. I’m still stuck between 5 eighteen wheelers on the turnpike and going nowhere near L’s apartment.

“Okay, Mom, I’m gonna’ call for reinforcements to come help.”

“What? I can’t hear you, you’re cutting out.”

“I can hear you perfectly,” I say.

“Well, I can’t hear you,” she says as her pitch rises in frustration. But of course she could or how would she know I said that?

“HANG UP, I WILL CALL YOU BACK!” Because somehow I think yelling is the answer.

My reinforcements are hard to find, so I call her back to say I’m working on it.

“Hello, Cathy?

“Yeah, Mom, I’m trying to get you help.”

“Oh, that’s ok, I was waiting for your call to tell you that as soon as you hung up it started working. He started to drive toward me, and that seemed ok, so he went to dinner.”

Ummmm…you couldn’t call me?

“Ok, well that’s good, thanks for the update.”

“Oh and Cathy?”

“Yeah?”

There’s a big hole in the wall where his headrest got imbedded into it when he went too fast in reverse, so we’re gonna have to get that fixed.”

You just have to Laugh……

Cathy Sikorski

 

 

 

 

A discussion with John Hancock……

Caregivers, Humor, Medicare, Multiple Sclerosis, Uncategorized, , , ,

One day a letter came from John Hancock (not the real one, I’m pretty sure he died a while ago) stating that my brother-in-law had a small long term care insurance policy in effect left over from his employment.

Every little bit helps.

So I called John Hancock to see how we could begin using the benefits, as he clearly qualifies based on the policy I had them send to me for review.

“Hello? I would like to file a claim for long term care benefits.”

“Ok, I need to ask a few questions,” said the nice polite young lady from John Hancock.

“Who are you?” she asked.

“I am his sister-in-law and his Power of Attorney.”

“Well, ok, you need to send us a copy of the POA.”

“Yes, I can do that, in the meantime can you send me the application for benefits.”

“Yes, I will send it to his address.”

At that point, I noticed that they had the wrong zip code for his address.

“I see you have the correct street address, but the wrong zip code. Can you correct that before you send it?”

“Oh, no, I’m sorry, I can’t change anything of his until you send me the POA.”

“But if you send it out, it will go to the wrong place.”

“Oh, yes, I see that. Well, would you like me to send the documents to your address?”

I pause for just a nano second, because experience has told me not to interrupt the ridiculous if it is in my favor.

“Yeah, sure, send it directly to me.”

I gave her my address.

“Now will you be filing that within one week?” she asked me.

“Well, he’s in the hospital for a few days, and may go to a nursing home for rehab or he may come directly  home and rehab there, ” I told her.

“Oh, well then you have to call back and request the forms after he gets home.”

“But it’s long term care insurance,” I said, “either way he will be under long term care.”

“I’m sorry, but I can’t send the forms until he’s home.”

“So,” I say through tears…..of laughter, “you can’t send the forms for long term care until he’s home and not in long term care. And then you can send it to my address until I get you  a copy of the POA to correct his address.”

“Yes!” she says brightly, that’s exactly correct!”080

You just have to Laugh…..”

Cathy Sikorski

Three times is the charm…I don’t think so….

Caregivers, Humor, Medicare, Uncategorized, , , , , ,

I have spent the last three Friday nights in the hospital emergency room. My brother-in-law has been suffering from pressure wounds, what we lay people would call “bed sores”. Since I’m no nurse and refuse to look at the area between his “gluteal crack and scrotum”, I had no idea it was getting worse, even with care.

On the advice of his home nurse I called the ambulance. My big mistake was I didn’t immediately call 911. You can’t just call the ambulance and say, no one is going to die in the next 10 minutes, so could you come over here and transport?. No, you must call 911 and make it as urgent as possible. Okay, I was a theater major, I can make an emergency if you need me to.

The second Friday night in the ER was because, they sent him home from the hospital too soon even though I begged them to keep him. Within 2 days of his going home and having home nurses and caregivers, and inventors of creative ways to make his wheelchair a place to sit without more bed sores, he was in pain with a draining wound and starting a fever. Five days of IV antibiotics later, they sent him home again.

The very first day the visiting nurse appeared she asked me why he wasn’t sent to rehab. Hmm, good question.

That same night, the third Friday night, he started acting a little ‘off’ around dinner time and within 2 hours, I got a call that he was exhibiting bizarre behavior. This had happened once before when he had a massive infection. I gave the home caregiver the pleasure of calling 911 and using her theatrics to get an ambulance poste haste (that’s acting talk for hurry up, someone’s sick but isn’t going to die in 10 minutes).

And this is where it gets crazy.

The first half hour in the ER, he’s got two technicians on either side of him with his arms out trying like hell to get a drop of blood out of him. He looks like a crucifixion. The entire time he’s saying in a monotone: “Ow.”

Like a hundred times: “Ow.”

“Where does it hurt?” I ask him.

“Everywhere,” he says.

That exact conversation continues for the next three hours.

After two hours of “Ow”, they tell me he’s third on the list for a CT-Scan. He starts to get a little crazy now. He’s thrashing around and my Mom and I are holding down his arms because he has IV lines in his hands and we don’t want him to accidentally rip them out. He’s already been crucified once.

Then he gets louder and now he’s saying: ” I can’t” and “Oh please” and “Ow” and we try to reassure him. He is thrashing and fighting pretty wildly now.  I have asked for a pain pill and I’m just about to pull a “Terms of Endearment” Shirley MacLaine mother of all hissy fits, when the nurse comes in with the CT-Scan tech behind her. She tries to give L a pain pill, but he won’t swallow water. The CT Scan guy disappears figuring he ain’t goin’ anywhere till he calms down, and then the Nurse high tails it all around the ER looking for CT guy to get his ass back here and take L for a scan.

Somehow they successfully scan him. NOW because all tests of urgency have been done, and there is no concern that a pain killer IV will harm him, the Nurse hunts down the doctor….who we still have not seen or talked to…..and comes in with some miracle drug that knocks him right the hell out in 60 seconds flat.

It is now almost 2 A.M. We have been there for more than 3 hours. He is finally resting, calm and not in any obvious distress. We go out to the Nurses’ station to see if they have any sense to confirm that he will be admitted. I answer all their questions. One of the doctors says let’s go back to his room so I can see if I have any more questions. I’m thinking she wants some HIPPA privacy rather than discussing this in the open hallway.

My mom and I walk into his room. He is resting so comfortably that we both let out a huge sigh of relief.

What is the first thing this doctor does?

She gently goes over to his bedside, looks down at him, puts her hand on his shoulder, shakes the hell out of him, pulls his eyelids up and yells: ” L! CAN YOU HEAR ME? L! CAN YOU OPEN YOUR EYES?”

My mom and I just look at each other and go “Ow” and walk out of the room……good luck with that Dr. Nutjob.

 

You just have to Laugh………..

Cathy Sikorski

Angels and Sharks…….

Caregivers, Humor, Medicare, Multiple Sclerosis, Uncategorized, , , ,
Shark in my beer!
Shark!

Angels really are everywhere.  As are shark infested waters. You just have to be aware of both.  As I was trying to get the best possible care for “L” in the hospital this week I was ‘attacked’ and rewarded at the most unsuspecting times.

 

 

After three days of hemming and hawing about how to address his pressure sores, the surgeon did a procedure bed side and decided that he needed to go in surgically the next day. When I came to get a progress report, the caseworker informed me that “L” would have surgery at 1:00 P.M.(give or take a few hours) and then would be immediately sent home.

“No,” I said calmly, the first time.

The caseworker just looked at me with a questioning glance.

“No,” I said calmly the second time. “He’s not having surgery and then put in an ambulance on a gurney with a huge wound on his backside and then sent home where he lives alone and I have to put caregivers in place. Especially since you have no idea when  that is.”

“Well, I understand,” said the caseworker, “but the doctor said he can go home.”

“Well,” I said, “if you understand, then you can tell the doctor the he doesn’t understand, and that this patient, who is non-ambulatory and needs care cannot go home ten minutes after surgery.”

We went round and round a few more times, and it wasn’t a square dance.  Finally she left and returned with the ‘good news’ that he could stay over night after the surgery. What she didn’t know,( or maybe she did as I just was saying: “No, no, no, no, no, no….oh yeah, and no.”) was that I would probably have stood in the doorway with both arms held onto either side refusing to let them take him out.

Angels or Angelicas are everywhere.
Angels or Angelicas are everywhere.

Everything goes well, and we get him home. I entice my sister and her husband to come for a lasagna dinner. It is a sham. I want them, a nurse and a mechanic to figure out a way to invent a seat cushion that will take the pressure off  “L’s” bum. They are kind and helpful and come to L’s apartment the next night. My sister expertly moves and manipulates ‘L’ in his bed so he stays off the sores. It’s poetry in motion how she tells us what to do and how to do it. Meanwhile her husband is taking measurements and cogitating on an invention for the wheelchair seat.

Then his caregivers show up. They take the reins and say, “don’t worry, we will make sure he is turned, fed, his blood sugar is checked and he stays clean.” I am so blessed.

I come in the next day, there is “L” completely naked, having a nice lunch, and saying: “I decided it’s easier for everyone if I just stay naked.” And while on some level that’s true, I really hope the cleaning lady skips this week.

Angels and Sharks, Angels and Sharks.

“You just have to Laugh……”

Cathy Sikorski

 

 

 

Sailed right back into it…….

Caregivers, Humor, Medicare, Multiple Sclerosis, Uncategorized, , , , ,

Lest   (yes, I used the word “lest”) you think a caregiver ever gets a true vacation. Think again. I do not deride my fabulous time in Key West as anything but spectacular and so needed. And I am grateful, truly I am.

A Caregiver's Dream!
A Caregiver’s Dream!

And just as I was winding down that lovely time in the sand and sun and wine and dine, the phone calls began. Trouble was brewing and you, oh mighty caregiver, you were needed pronto.

One of the several disasters going on was that Aetna, once again denied an ambulance transport. I know. I know. We are all so very tired of this same story. But it just gets better and better.

Before I left on vacation, I went to the doctor’s office, who ordered the MRI, gave them a copy of the denial and asked them to write a letter explaining that my brother-in-law is not at all ambulatory and needed the gurney so that he could be lifted on to the MRI table and then transported back home. The woman who handles that task was out to lunch. Oh please, that joke is just too ripe for the picking!

“Hello, is this Cathy?”

“Yes, this is the administrator from the doctor’s office. I did get a call from Aetna and told them we did not order an ambulance for your dad (yea, sometimes I’m his daughter, sister, wife, whatever works). And when they said a ‘Cathy’ called I told them it was his daughter. So that’s why they denied it. ”

First of all, thank you? Thank you for telling them you didn’t order the ambulance and for not explaining that you did though, order the test, and that he would need an ambulance to get there.

What I said was:

“Yes, I called Aetna because for the last three years, your office refused to do that, and so I made the call to get him to the test. You see, he’s not ambulatory so he can’t have any tests on a table unless he goes by gurney.”

“Oh that’s not true, he could go by wheelchair.”

Yep. She really said that. Or she was still out to lunch. I’m not sure which.

“Noooooooooooooo…..he can’t get out of the chair and up on the MRI table.”

Dead silence.

“Well,” said the administrator, “I’m going to have  to have to check with the doctor. We’ve never written a letter before for something like this.

See, not only have they done this before, but I actually sat at the desk with the last administrator and helped her write the letter.

“So, if the doctor approves this, in the future will you call the ambulance for any test he might order?”

“Oh no. We don’t do that.”

You have to go on vacation and then……………

“You just have to Laugh….”

Cathy Sikorski

What do a Pediatrician and Blanche DuBois have in common?

Caregivers, Humor, Medicare, Multiple Sclerosis, Uncategorized, , , , , , ,
Fun at the Pediatric Dentist!
Fun at the Pediatric Dentist!

I have been searching for 2 years for a dentist to treat my brother-in-law, “L” who has MS. The issue is that L is wheelchair bound and cannot get out of the chair at all without the assistance of at least two people or a Hoyer Lift.

The dentist, eye doctor and any other pyhysician or medical facility that we have to go to, must have a wide enough room for him to enter, leave, turn around and be treated in. Thanks in great part to the Americans With Disabilities Act, most medical facilities have come to the place where L can be accommodated. But the dentist is a challenge.

Most dental offices here in Smalltown, USA are converted homes and even if we could get into the lobby, we can’t get into the treatment room. And on top of all that, since L can ‘t move from his chair to the dental chair, many dental offices I have contacted would not see him.

To be fair, his own dentist offered to try and get the lift from the wheelchair van to come even with the outside deck of the dental office, and then maybe we could skootch him through the glass sliding doors and into treatment. And I considered it until we had snowstorm after blizzard after ice storm.

And then L broke a tooth.

Now I had to put this into high gear.

I called the MS Society, who put me in touch with a dentist who was far away. Kindly, that dentist agreed to see him, but had no openings for 3 weeks. I called my own dentist who had no access at his office, but I thought he would have a recommendation. The first office was unable to help me. The second dentist was a pediatric dentist, so I was pretty sure that was going to be a wash. Never assume.

Pediatric Dentist, Dr. Zale, agreed to see L. We entered the office and were immediately surrounded by picture books, Legos, toys for every age, and a beautiful array of kids from toddler to teen. I told L not to smile too much because the broken canine in his mouth might scare the little ones. But those kids played around the wheelchair like it was a dining room chair at home. If the toy they wanted was on the other side of L, they just looked him straight in the eye and walked around him to play.

Dr. Zale and his staff took my brother-in-law into a very large and airy treatment room, somehow got him x-rayed and fixed him right up. There was no time to do a standard cleaning so they made an appointment for him to return before I even got back to the desk to pay. He was now their actual patient!

Six weeks later, the Jeff Gordon of wheelchair drivers, my brother-in-law, hits the high speed button on his wheelchair, bonks his head on his computer and completely breaks off the new tooth. I called Dr. Zale, they got him right in and took yet another two hours to fix that smile right up. Because it had taken longer than they expected the front desk ladies said they would just send me the bill. This is the bill I received:

No Charge per Dr. Zale..
No Charge per Dr. Zale..

Sometimes you just have to be ever so grateful for the kindness of strangers,  and

You still just have to Laugh…….

Cathy Sikorski

I still got it…..sort of…..

Caregivers, Humor, Medicare, Uncategorized, , , ,

As I enter the stage of life called “aches and pains,” I am sometimes rewarded with a girlish moment.

I went to visit my mother-in-law in the assisted living facility shortly after we moved her in there. I tried especially hard to get her involved in activities that were age appropriate. She was, after all, 94 years old, so I didn’t think she needed to learn how to play bridge or try Zumba. But she could go to the sing-alongs, play bingo for 25 cents a game, and sit at the big puzzle table with other ladies and gents and gently touch the pieces while looking for their ideal slot.

So off we would go to the activity of the day. I didn’t mind playing bingo or helping with rudimentary crafts, And I loved ice cream sundae Wednesday. Yeah, that was pretty terrific. My mother-in-law loved that too. We shared a common appetite for a good sundae on Wednesday.

I would go two or three times a week, just to make sure she wasn’t sitting in her apartment sleeping while watching TV. My mother-in-law was a very social person. She was charming and enjoyed talking to people. The aides loved her because she was kind and she was interested in what you had to say. I wanted to encourage her to have places to go and people to talk with.

I became a ‘regular’. A certain contingent of the locals who engaged in the same activities were friendly and chatty with me on all my visits.

On some days, I might be dressed up, if I were going to or coming from a business meeting. It would be like CHEERS when I would go through the lobby, the activites room, the dining hall ,or down to the nurses station. People who lived there and worked there would say, “hey”, “hello”, “Hi Cathy, how are you?” Very pleasant ,indeed.

On this day, I was looking pretty spiffy, and went down to the mailboxes to check for my mother-in-law’s mail. As I exited the elevator, there was a gentlemen, who I didn’t know, walking slowly with a cane coming towards me with a small pile of mail in his hands.

“Hello,” I said.

“Hello,” he said.

I thought just in that moment I detected a little sparkle in his eye. Charming, I thought.

“Well,” I said, “I see my timing is perfect.”

I glanced down at the mail in his hands to indicate that I had come just in time to get today’s mail.

“Your timing is absolutely perfect, ” he said.

I swear to you, he looks me up and down, a smile of approval slowly spreads across his withered face and he said:

“Are YOU moving in here?”

I would have flicked my hair, but it’s short. I just gave him my best girlish laugh, shook my finger at him, and moved to the mailboxes.

You just have to Laugh…….

Cathy Sikorski

What’s in a name?

Caregivers, Humor, Medicare, Uncategorized, , , , , ,

The generation that I mostly have cared for in the last 20 years is the ‘greatest generation’ born in the early to mid 1900’s. These wonderful people  were often here as children and maybe grandchildren of immigrants. We grew up as children, grandchildren and sometimes great-grandchildren of immigrants. Suffice to say that hardly any of us were far from the boats or the shores of Ellis Island. As a consequence, our parents always wanted to know the ethnic derivation of the families of our school chums, our friends, our bosses, our co-workers.

This wasn’t necessarily a point of prejudice as much as it was often a point of reference. So if that nice girl Maria came home with me, was she Italian? Who were that boy, Tommy’s, people? Does that last name end in ‘ski’ or ‘sky’ because that could be the difference between Polish and Ukrainian. Our parents and grandparents just wanted to know. In some ways, I think it made them feel worldly or cosmopolitan to ‘figure out’ just where those surnames and your people came from.

When I met my mother-in-law, my husband and his entire extended family were very proud of the fact that they were 100 percent Ukrainian. My daughters have always teased me that I muddied the waters with my crazy quilt of an ethnic background that is only half Italian and nothing else on my  mother’s side that anyone can actually attest to. And, as punishment for this transgression, my daughters threaten to bury me in the “Ukie” cemetery. Yes, the Ukrainians have their own cemetery. So maybe they do want to keep out riff-raff like me. And I will haunt my daughters from the dead if they bury me there.

Since we are so dramatically aware of being politically correct, you don’t hear this kind of conversation outside of elder care facilities too much.  But once my mother-in-law was comfortably ensconced in her assisted living facility, ‘ethnic-geography’ was the game of the day.

“So, Repko, is it? Where does that name come from?”

“Is it MacClellan or McClellan, because that would be Scotch or Irish, right? ”

“Are you Pennsylvania Dutch or are you a real German?”

These are the conversations you would overhear in the lobby, the dining room and at Bingo. It seemed harmless enough because everyone engaging in the game would just nod their head or say, “Oh” and that would be the end of it.

Since it was a long-standing joke in our family that I was not Ukrainian, I thought that my ethnicity with my husband’s family was at least on the approval list.

This particular day, my mother-in-law was recuperating in rehab for a gangrenous toe. She had been very, very sick and her recovery was very slow. But within  several weeks, she was remarkably back to her old self and on the mend so that she would be released from rehab back to her assisted living apartment any day.

We took a little stroll in her new special shoes that were necessary to protect her injured toes and feet, then we sashayed back to her bedroom for a little rest. She was in such good spirits, that I was telling her about all the great things waiting for her back at her apartment.

“So there’s bingo, and your friends miss you at your table, and since the weather is getting nice we will be able to go outside for walks in the garden. Isn’t that nice?”

“Sure,” she said. “I’m getting a bit tired now. These shoes are hard to walk in.”

“I know,” I tell her. “I’m tired myself, my back has been acting up and I just can’t seem to get comfortable to sleep.”

“Oh well,” she said with a  chuckle that I recognized as “this is about me not you.” And  as we sat there in  comfortable silence in her breathtakingly warm room for awhile,we both start to nod off. Her head was lolling to the side and I was losing the battle with my eyelids, and I sort of mumble under my breath:

“Aren’t we a pair? A Ukie and an Italian….”

She sits bolt upright and says:

“YOU’RE ITALIAN???? I thought you were Polish!”

You just have to Laugh…….

Cathy Sikorski

Just searching for approval….not PRE-approval

Caregivers, Humor, Medicare, Multiple Sclerosis, Uncategorized, , , , ,

I have been so lucky with my brother-in-law, L this  past year. He has been pretty healthy for a guy with MS and relegated to a power wheel chair. The year before he was very sick off and on and required boat loads of my time. But this year, he has just been doing remarkably well, which led me into this complacent place of thinking all is well in the medical world….at least with L.

And actually, he’s fine–ish. But we are now in a push to get some testing and medical work done before the end of the year. And I just forgot how to do things, and how things would be done to me.

On Monday, L needs an ultrasound to check a worrisome kidney cyst. Okay,  I set up the test at the correct hospital and the correct facility of the hospital. His Medicare insurance requires him to go to certain facilities. Sometimes the ordering physician knows that and sometimes he doesn’t. But after 10 years, I KNOW it and so I set up as many of these tests without their “help”, so we don’t have insurance issues in the future.

I make sure the test is between his breakfast and his dinner, because even though he’s gained at least 40 pounds in the last three years, he gets really cranky if he misses a meal. I get that….it’s part social, part his inalienable right, and part “I’m hungry!!”. Okay, no sweat.

I call the ambulance transport and set up transport to the facility and the eventual doctor’s appointment to discuss the results of the test. And I even make sure the blood work is scheduled to be done at his apartment as a “home draw”, which requires a request to the lab directly from the doctor’s office, because I am not PERMITTED to ask the lab to come to his apartment, since  he is wheelchair bound and has no  transportation….ONLY the doctor can do that. (who of course, doesn’t ever remember that and so must be reminded by me, and then the lab calls me to make sure they can come at a convenient time…UGH does this really make ANY SENSE TO ANYONE????)

And then I realize, three days later, and three days before the test. Oh crap, I didn’t get PRE-CERTIFICATION for the ambulance, which must be a gurney and not a wheel chair transport  (which we will discuss another day) because he must be put on a table for an ultrasound and he cannot get out of the chair and onto a table by himself.

So…………….I call for the pre-certification:

“Hello, I’m calling for a pre-certification.” (This of course, after pushing 42 buttons and getting disconnected, and being asked at least four times: “are you calling for a pre-certification?)

“Okay, can I have the name of the member, his ID number, his date of birth, his first born.”.(okay they didn’t ask for that, but they might as well have)

And after I get it all squared away, I think…

“Now, you will have to have the ambulance transport company call us to request that.”

“Well, I’ve tried that before. First of all, they won’t do that. Second, in order to request this you need the prescription, the diagnosis code and the physician’s name, am I correct?”

“Well, yes, so that we can approve that it is medically necessary for him to have transport.”

“Well, the ambulance company does not have the prescription, I do. And furthermore, I wouldn’t give it to them, nor do they want all this medical information on my brother-in-law. Not to mention that I’m pretty sure it would violate like 100 kinds of HIPPA laws to be passing around his diagnosis and doctor names and medical test information, don’t ya’ think?”

“Umm, well………Can you hold for just a second?” the nice lady at the insurance company says to me (the mean lady trying to get ambulance transport for the hundredth time with the same argument for the past three years)

“Okay,” she says as she comes back on the line, “can you give me all of that prescription information?”

“Of course,” I say. NOW, I hope against hope that we are really almost there.

“Well,” she says, “that will do it!” Very bright and chipper I might add!

“Oh, no, no, no,” says the voice of experience, “I need an authorization number,” knowing full well that the ambulance company won’t transport without it.

“Well, okay, I can give that to you, but this has to go to our medical team to determine if it’s approved. You will get a confirmation in 2 to 3 days.”

“Okay,” I say, “just give me the number.”

Because I know their dirty little secret. They will approve this BY MAIL in a week, if I’m lucky. But I will not cancel the test, because they will put on their approval that the transport is approved for the day of the test, effectively making it retroactive. But if  I wait for pre-approval, I will magically have to know when the approval will come in to schedule the test since they only approve a specific date. Don’t overthink it. It’s complicated and stupid. I’ve played this game so many times, I just know how to do it. Trust me.

 

You just have to Laugh……………………..

Cathy Sikorski

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