Tag Archives: AARP

And You Thought “Mooning” Went Out With Hot Rods…………

In the beginning of 2017, Medicare implemented the new Medicare Outpatient Observation Notice which seems to have the same effect as the old ‘mooning’ we think about from American Grafitti.

You see, MOONing in Medicare (sounds like a love song from Cole Porter, doesn’t it?) means that within 36 hours of entering a hospital, if you will not be admitted, but only kept under  “observation,” they must inform you with a written explanation.  This is the form, if you’d like to see it!

MOON FORM

The problem with this form is the unintended consequences it might have for you, if you are on Medicare, or your loved one, if you are a caregiver for someone who is on Medicare.

If a patient is placed under observation, typically in the Emergency Room, and is never formally “admitted” to the hospital, Part A hospitalization of Medicare does not pay. In other words, you are paying as an outpatient.  For a quick trip to the ER (is there such a thing?) that’s no big deal. After all, the Part A deductible is $1340.00 so you may not even spend that much if you’re only there a few hours.

However, if you are there a few days, and you stay on observation, it is likely that you will start racking up fairly high medical costs with co-pays for every service you are getting. Not to mention any drugs, that likely will not be covered by your Part D while you are in the hospital. It’s complicated, scary and could be costly.

The worst result could be that you are sent to rehabilitation, and because you never met the “admitted to the hospital for 3 days” requirement to have Medicare pay for at least 20 days in that rehabilitation center, you are now responsible for a significant bill coming out of that rehabilitation center. This has happened to people to the tune of thousands of dollars.

So what can you do?

This advice comes directly from this AARP article, which oddly was written before MOON became a regulation and before the MOON form existed. So I have added two of my own suggestions at the end:

Medicare: Inpatient or Outpatient?

  • Ask about your status each day you are in the hospital, as it can be changed (from inpatient to observation, or vice versa) at any time.
  • Ask the hospital doctor to reconsider your case or refer it to the hospital committee that decides status.
  • Ask your own doctor whether observation status is justified. If not, ask him or her to call the hospital to explain the medical reasons why you should be admitted as an inpatient.
  • If, after discharge, you need rehab or other kinds of continuing care but learn that Medicare won’t cover your stay in a skilled nursing facility, ask your doctor whether you qualify for similar care at home through Medicare’s home health care benefit, or for Medicare-covered care in a rehabilitation hospital.
  • If you go to a skilled nursing facility and have to pay for it yourself, you can try formally appealing Medicare’s decision. When you receive your quarterly Medicare Summary Notice, make a copy and highlight the facility’s charge. Send this to the address provided on the notice with a letter saying you want to appeal Medicare’s decision of noncoverage on the basis that you should have been classified as an inpatient during your hospital stay and not placed under observation. If this is denied, you can go to a higher level of appeal, following instructions on the denial letter.

Additionally,

  •         You can refuse to sign the form. All that does is make the hospital sign it, and make them a bit testy. But it signifies that you do not accept this and hopefully is evidence on Appeal that you were trying to fight the observation status.
  • You can take your patient home. I am not recommending this, especially if the whole reason you are fighting ‘observation status’ is because your patient is very sick and you are certain they will end up in the hospital, a rehab center, or a skilled nursing facility after this event. But one of the problems with Medicare is that they penalize hospitals for re-admissions. So discussing the possibility that you might take your loved one home, that might force a re-admission, may move them to admit your loved one.

Sometimes this feels like the “Art of War,” when dealing with healthcare issues. Being forewarned is being forearmed, as they say. Seems like anything is better than being MOONED!

“You Just have to Laugh…..”

©2018 Cathy Sikorski

ALMOST EVERYONE IS FALLING FOR THIS NEW MEDICARE CARD SCAM! PROTECT MOM!

This is so important, that I scrapped my blog for today, for this. And since it is Friday afternoon, I’m going to repeat it again early next week. Please, for the love of God, tell your parents, your Seniors,  your neighbors, your friends,  even your enemies and maybe your pets…… that bad, bad people are scamming those with Medicare about their new cards.  THEY ARE FREE and NO ONE WILL CALL YOU ABOUT THEM:

NEW CARDS MEDICARE FRAUD ALERT: YOUR NEW CARD IS FREE!

With Facebook Friends like this…Who Needs Enemies?

Two years ago, my Mom called me, practically in tears.

“Roberta was so mean to me,” she said.

I’m thinking, “who the hell is Roberta?”.

“She’s from my medical insurance carrier. I called to ask her why a bill wasn’t paid and she said I should never have been given this insurance and I’m going to have to pay back every penny from the last 15 years.”

“And,” she went on with a worried tone, “you told me to NEVER pay a medical bill. So I don’t know what to do.”

“Calm down, Mom. We will get this worked out. It will be okay.”

My first reaction was this:

I did tell my Mom never to pay a medical bill because her insurance covers everything.

My mom has Tricare For Life Medical Insurance. This insurance is for Veterans and their families, spouses, widows, children. My Dad died in a helicopter crash as an Army pilot on October 10, 1961. My mother had five children all under the age of 10 and was pregnant with her sixth child. So I kind of think my Mom is entitled to this insurance.

The thing is, Mom never claimed this insurance until my step-father passed away in 1998. She didn’t even ask for it. She already had Medicare and AARP. But when she applied for her widow’s the Veteran’s Administration made her jump through all kinds of hoops with documentation and then GAVE her this insurance.

My mom is a Virgo.

Why does that matter? She has kept every single piece of paper that has ever come into her life. So she has every piece of documentation that transpired fifteen years ago with the Veteran’s Administration. The VA put her on the wrong insurance.

So two years ago, they began threatening an 87-year-old widow, who raised her family of six children without a father, a man never even made it to 30 years old, that she would be thousands of dollars in debt to them because of their mistake.

After talking to seven different people at seven different government administrative places which most people never even heard of, we refiled all the documentation from 15 years ago.

I wrote much of this post two years ago.  And much of the problem has been resolved after mountains of paperwork and dozens of phone calls…one that occurred while I was drinking in Times Square. Hey, if they call, you answer, because they may never call back.

I said this two years ago, probably after the drinking incident in Times Square:

 I know from the last 25 years of caregiving and jumping through administrative hoops that this story will not have an easy ending. There’s going to be reams of paperwork. There will likely be boatloads of nastiness. There may be a lawsuit. But in my best, Scarlett O’Hara voice: “As God is my witness….my mother will never pay one dime to fix this problem.”

There’s one small problem that persists. The government agencies just can’t agree and  are trying to collect $687 from my sweet ol’ mom that they think they are owed from overpayments. I still have people in all these agencies working on it and I have not yet caved to paying money to make it go away, but still…..I am amused by the latest missive from one of the insurers trying to collect funds:

Fun things to do while fighting with Insurance
Like us On Facebook……Indeed.

Hmmmm…..I’m struggling with that friend request.

©Cathy Sikorski 2018

 

Laugh….and the world laughs with you……………

Okay kids….it’s time to laugh, even just a little bit…

How do you know if you are a caregiver?

  1. If you are buying wipes and you don’t have a baby…..
  2. If you have dozens of medications in your house and none of them are yours…..
  3. If you wish some of them were yours…………..
  4. If, when someone says ‘whine’, you break out a long-stemmed glass……..
  5. If you get into your car and your car takes you to a nursing home but that’s not where you were going……….
  6. If you’re so tired that you used Preparation H to brush your teeth before bed….
  7. If you have dishes in the sink, laundry in the hamper, unpaid bills, and you drop everything to take your Mom to the doctor and the hairdresser and lunch and the bank and the pharmacy and the grocery store and the dry cleaners…….
  8. If you have on two different shoes…..
  9. If you just recently started using swear words that never came out of your mouth before….
  10. If you are so well-versed in medical-speak that they ask you to check on a patient in Room 612 ……..
  11. If when you say you’re going to the Vet, you don’t mean a place where animals get medical care….
  12. If you use so many acronyms like HIPPA, AARP, HMO, DME, SNF, OT, PT, ER, that you start spelling your kids’ names instead of saying them….
  13. If date night is now every Friday night in the Emergency Room….

Or this……

 

Check with your spouse, your significant other, your friends, your therapist….you just might be one of us!

“You Just have to Laugh…..”

©2017 Cathy Sikorski

You might be a Caregiver….Part One

Just as I was sitting down to bring you the next installment of caregiving comedy, my computer decided the last laugh would be on me. Done, died, dead. With no warning, no goodbyes, no fond farewells, just dead.

These two weeks provided lots of time to come up with all the joys that caregivers experience. So in a huge nod to Jeff Foxworthy, I bring you the first installment of:

“You might be a Caregiver……”

  1. If you know Medicare’s phone number and website without Googling….You might be a Caregiver….
  2. If your search for an Assisted Living Community for your Mom starts to look like a nice vacation spot for you and your spouse….You might be a Caregiver
  3. If you cancel your dentist appointment to attend Ice Cream Social Wednesday at your Dad’s nursing home, because you want the ice cream….You might be a Caregiver
  4. If you know your parents’ Medicare number, AARP number, United Healthcare number but not your own cell phone number…You might be a Caregiver
  5. If you feel the need to correct WebMD about all the missed additional symptoms of a urinary tract infection….You might be a Caregiver
  6. If your iPhone calendar has words on it like ‘catheters’, ‘hearing aid’, ‘urologist’, or ‘dentures’…..You might be a Caregiver
  7. If going to the Emergency Room is like Cheers where they know your first name and how you take your coffee…..You might be a Caregiver
  8. If you took the black Sharpie to your husband’s underwear to mark it for the wash instead of your Mom’s for the nursing home…..You might be a Caregiver
  9. If you’ve had more knock-down, drag-out fights with Insurance Companies, Hospitals and Doctor’s office than Muhammad Ali…..You might be a Caregiver
  10. If everyone around you thinks you are speaking in tongues because you are constantly saying, PT, OT, UTI, or DME….You might be a Caregiver

And this is only the beginning, my friends. After all, this is a new computer, so there’s lots of room for humor here now!

“You Just have to Laugh……”

©Cathy Sikorski 2016