Tag Archives: Health insurance

Hot Fun In the Summertime…..

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Yay! It’s summer…..

If you are a Baby Boomer, or a baby,  or anyone…..it’s summer and you want to take a vacation! But guess what?!? People get sick on vacation, too!

I attended a Medicare seminar with my Mom the other day…and that is so another story…but one little-unnoticed tidbit stood out for me….Medicare won’t pay for your vacation illness, sort of.

Did you ever notice that everything we need to care about in aging is ‘sort of?’ I sort of have a knee problem; Insurance sort of covers that; Eggs are sort of good for you;  You sort of shouldn’t drink with that medication. I digress, sort of.

We finally reach the age where we want to travel, travel, travel and there’s a big ol’ mousetrap in the middle of it. You will be entering a Rube Goldberg universe of obstacles if you don’t prepare.

If you go on vacation with Medicare all by itself and don’t take any of its friends…nope, no good, won’t pay if you trip on the gangplank of the water taxi in Venice, or puke your way through the Galapagos Islands. Certain Medigap policies will cover you for 80% of the cost in your first two months of travel. Medicare Advantage might cover some aspects of an emergency, sort of.

So it’s all kinda’ sorta’.  You want to have a vacation and not just in the summer. You want to travel for fun and fun and more fun, while you’re healthy and can pay for it. C’mon universe…I earned this!

So what can you do?

  1. Call your insurance provider and ask…Do you cover travel? Domestically and abroad? Believe it or not, some Medicare Advantage will not cover you from state-to-state, so if you’re a snowbird….yikes! Check it out.
  2. Do you pay for airlifting? Getting me home from the Machu Picchu where I fell climbing the Stairs of Death on Wayna Picchu cause I forgot I wasn’t a Millennial? Do you?
  3. How do I file a claim for unexpected medical expenses when I get home?
  4. What if my preexisting condition requires some unexpected medical care while I’m traveling, do you cover that? Presumably, if you have a preexisting condition, your health insurance carrier already knows that.

But what can you do that’s best?

Dig down deep in your heart and your pocketbook and buy travel insurance. Make sure it covers all these possibilities. Because the truth of the matter is, it’s a few extra hundred dollars. If you’re paying thousands to take a glorious trip, don’t be cheap or chintzy now. Rest assured, you will probably not use it. And then thank your lucky stars, if you need it.

 

Bon Voyage!  Love ya’, mean it!

“You Just have to Laugh…..”

©2018 Cathy Sikorski

Don’t Pay Those Medical Bills…..Part Deux

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I’m back…..and boy do I have a story for you!

I try so hard to let you all know the important things going on in caregiving both legally and practically. It’s so difficult for us to stay abreast of all this crazy, complex information. And yet, I too, fall prey to the insidious actions of those who would undermine all of us.

I did the one thing, the one thing I tell all of you not to do.  Okay, I didn’t actually do it, but I sat side-by-side with my husband and watched him do the ONE THING I TELL ALL OF YOU NOT TO DO.

Here’s the tale:

My husband was having a routine colonoscopy. He hates that I share personal information, but in this case, it’s critical that you know exactly that. For your protection, he’s allowing me to reveal he has routine medical care. Yes, he’s that great.

The day before the procedure, my husband gets a call from the hospital. They tell him that they have called our insurance and he will have to pay a  $1,190 co-pay. Yes, that is One Thousand One hundred Ninety Dollars.

This seemed really odd to me. Routine care is always covered. But I will admit that even with relatively good health insurance, we have been paying larger and larger sums every year for co-pays, deductibles, and God-forbid, out-of-network costs.

Since the hospital said they checked with our insurance and this would be our co-pay, we took the checkbook to the hospital.

Now, I bitched about this to anyone who would listen.

“Can you believe this? Almost $1200 for a CO-PAY for a ROUTINE COLONOSCOPY? No wonder people get cancer! No wonder they won’t get routine tests! That’s a mortgage payment for lots of people! That’s a car payment! Hell, that’s a mortgage payment AND a car payment for most people!

I was hopping mad. We are fortunate that we could pay, but it’s not without a big “OUCH.” I also know that there are many, many people who absolutely cannot afford $1200 out of nowhere for a ROUTINE PREVENTATIVE MEDICAL PROCEDURE. Yes, I’m yelling. Yes, I’m using exclamation points. I was pissed.

When we got to the hospital, the clerk asked how much did we want to put down on our colonoscopy. Like it was a car, a house, or some nice furniture.  Because they were not taking him back there for those great drugs until we made some kind of a downpayment. For God’s sake.  We just don’t want cancer….which clearly we probably wouldn’t be able to pay for either.

But I sat there, speechless, as my husband wrote a check for $1,190.

And then I got the EOB. That ‘s the Explanation of Benefits. I read every one, just to make sure our medical bills were processed and to see how much of a bill I can expect.

Guess what? The EOB for my husband’s colonoscopy showed that it was a routine procedure and we did not owe anything. Not because we owed a co-pay or a deductible that we paid in advance…but because WE DIDN’T OWE ANYTHING.

Yep. We called the hospital and the billing department said: “Oh, that’s just an estimate that they give you, they don’t really know what you will owe.  We will return all your money. But you need to wait at least two weeks.”

My husband is the calm one in this house. Thank God, because they would only discuss this with him. If I had a crowbar, a siren, or a hammer that phone call would have gone so very differently.

P.S. My husband would not have checked the EOB….and I feel very certain that $1190 would have disappeared forever.

Soooooooooooooo……DO NOT PAY THOSE MEDICAL BILLS…………….JUST WAIT. I wrote the book on it and still had to be reminded the hard way.

“You Just have to Laugh……..and take your own advice……”

©2018 Cathy Sikorski

Call Me, Maybe…..for Quality Assurance

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My Publisher  Extraordinaire campaigns for everyone to just ‘Be Nice.’ I would like to take her advice and suggest we start with our Veterans and their families.

Last week the Veteran’s Administration hung up on me. Granted, I wasn’t giving the guy what he wanted….but he HUNG UP ON ME….AT THE VETERAN’S ADMINISTRATION.

Those of you kind readers who follow my blog, know that I have been in a kerfuffle with the VA since January when they unceremoniously stopped my 87-year-old mother’s health insurance. They discovered a mistake they made 15 years ago, by putting her on the wrong insurance. So they just cancelled her policy. They didn’t bother to fix their mistake. They didn’t  bother to put her on the correct insurance. They didn’t even bother to tell her that they cancelled her insurance.

So, as I told you in the past, my Congressman Representative Ryan Costello (R-PA) (well actually his amazing administrator, Lisa Reynolds) helped me quickly and efficiently fix the problem. If you’re having problems with the VA or any other governmental agency, I

Your current Congress might be more helpful.
Your current Congress might be more helpful.

highly recommend you ask your Congress person to help you. Really. Don’t waste too much time trying to fix it yourself. You will be quite surprised and, hopefully, happy that  your Representative or Senator has staff who are there to help you. Try it. That’s what we pay them for, to work for us.

All that being said…..please VA don’t hang up on us. Even if you don’t like what we are saying, don’t engage in the rudest form of behavior.

I wasn’t yelling, complaining or even causing trouble. I just wanted to refrain from filing additional paperwork with the VA, if they didn’t need it, thereby making everyone’s life easier.

This is what went down:

“Hello, this is Bob from the VA, we are returning your call as requested.”

“Hi, Bob, I was calling for my Mom who has a complicated case that goes back 15 years.”

“Well,” said Bob. ” what do you want me to do? Look at 15 years of claims?”

“No, Bob,” I replied, “I just want to look at one provider, if you can search by that to see if you have already processed that claim,  I won’t resubmit it.”

“Okay,” replied Bob with a bit of exasperation, “What’s your address?”

“Do you mean my Mom’s address? Because she is the insured.”

“No,” replied Bob, getting a bit testy, “I want your address.”

“Well see Bob, that has caused problems before, because my Mom and I don’t live together and………….”

He said: “When you’re ready to give me your address, you can call back.”  And he hung up the phone.

I tried to call back, but there was a 13 minute wait time which is standard procedure when you call the VA.  Which is why Bob was returning my call in the first place, three days later.

Then I just thought, okay. I tried to help. I’m just gonna’ file this and make you do the work twice. And I may begin to implement my new practice where everyone I call for this kind of business I say before the representative can help me:

“This call is being recorded for quality assurance.”

I’ve tried it a few times. It brings silence and confusion. But no one has been rude or hung up on me since then. I say we all try it…….you know, for Veteran’s sake!

“You just have to Laugh…….”

©Cathy Sikorski 2016

Want a Laugh? Call the VA……

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Although my caregiving duties have changed some, I still, like many a dutiful daughter have to deal with issues of the elderly.

As I warned you a few weeks ago, my Mom is steeped in a battle with the Veterans Administration.  They reneged on her insurance about a month ago. This insurance is for widows of Veterans. My mother was placed on this policy 15  years ago. She’s used it for all her health needs since then, until that  fateful day when they discovered their error. For points of clarity, my Mom was put on Insurance Plan A and should have been placed on Insurance Plan B.

As you can imagine, in the world of government bureaucracy, this is no easy fix. Nobody knows what to do or how to repair this problem.

What they do know how to do is create all kinds of havoc that sends little old 87 year-old ladies into shock and apoplexy.

They have begun to  take back all their insurance payments over the last year or so, thereby causing my mother to receive bills from all her medical providers day after day after day.  You may not know this about the elder generation, but if they get a bill, they pay it. Case closed. Even though these bills will eventually be paid by Insurance B, this generation can not abide being beholden to anyone, especially their doctor.

After yet another three and a half hours on the phone with fwo divisions of the Veterans Administration…Insurance A and Insurance B customer service, and  DEERS   (Defense Enrollment Eligibility System) a department from the Department of Defense, I had my Mom actually hear a customer service rep tell her not to pay any bills until this is resolved.

The first guy was named Kirk. He asked me if I had spoken to him three days ago. I assured him I had not since I was out of the country.

“Hmm” he said, because I ‘m sure I had a call from some lady about this same problem, which I never heard of until this week.I guess Insurance A is running a review of all their insureds to see who is on the wrong program…hahahha..”

Yeah. Hilarious.Oh, and by the way, I think my mother may have inadvertently started this shake down of widows from the VA about a month ago.

Person number 2 , after our second 20 minutes on hold, was David. He, too, was flummoxed by this account of our woes and told us that he could only suggest we call DEERS, because It looks like DEERS needs to confirm that my father died on October 10, 1961.

Person number 3. after a very brief 10 minute hold was Bill. Bill was ever so kind. He could see that this was a grand problem. He couldn’t understand why the two insurance companies,under the VA would not accept a death certificate (yes, my amazing, organized- with-every-shred-of-paper-ever-touching-her-fingers-Mom has  a death certificate from 1961). Then Bill searched the records and said because the ‘incident’ (meaning my father’s death on active duty) was so long ago they would have to put in  a request to …you guessed it….the Veterans Administration, to confirm my Dad’s death.

One more transfer to another department of the VA, with a lovely 20 minute wait to Stuart.  It was almost taking as long to explain this journey as it was to be on hold, but explain it I did. And, this is a true story, mind you, while searching the data base of all the information under my Mom’s name and my Dad’s name, I think Stuart thought he put me on hold. Alas, this is what I heard in his exasperated voice:

Only I KNOW the ANSWER...she said.
How do you spell “Cluster$#!!

“What a cluster fuck!”

Yep, I burst out laughing, ’cause well, yeah…indeed.

The journey continues with me filing some documents they’ve asked for, waiting for a confirmation that my Dad has been dead for 55 years to come from the Veteran’s Administration to my Mom, so that we can then send it to the VA insurance.

That’s how it has to be done they tell me. The VA can’t send it the the VA, the widow has to do it. And at least a few more weeks of comedic material for a blog called..

“You Just have to Laugh…..”

©Cathy Sikorski 2016

Don’t Worry…..We Will Take Care of You……

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Last Friday 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 t 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 widows benefits after my step-father passed away, 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. She sent them her marriage certificate to my step-father and his death certificate.

Then, they put her on the wrong insurance.

And now they are threatening an 87 year-old widow, who raised her family of six children without a father, who never even made it to 30 years old.

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.

Now we wait.

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.”

It helps that I’m a lawyer.

I know you don’t think there could possibly be a laugh in here in any way. But as I was looking at some of the documents from her insurance company, I saw this:

Fun things to do while fighting with Insurance
Fun things to do while fighting with Insurance

Really?

Hmmmm…..

“You Just have to Laugh…..”

©2016 Cathy Sikorski

Just checking………

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As my life changes now from caregiver to Executor, trust me. the frustrations and the sense of humor still need to be in place.

I spent two hours yesterday calling all the places that send money to my brother-in-law to thank them, but notify them that he has passed away.

I called two pension plans, one health insurance company, one drug insurance company, and one health insurance reimbursement company. Five phone calls shouldn’t take that long. However, there is no “press 9” if your loved one has passed away. By the time I was transferred to each appropriate department and repeated my story over and over again, I started to feel the ghost of caregiver frustration rearing her ugly head.

Truthfully, most customer service people were quite kind and sympathetic.

But there’s always one, isn’t there?

The health insurance reimbursement company was set up by my brother-in-law’s former employer to reimburse each individual for their health insurance premium as a temporary benefit when the employer no longer wanted to be in the health insurance business. This started last year when I had to wade through 64 health plans to pick the best one and then send in a cancelled check to have reimbursement sent directly to my brother-in-law’s checking account. I am certain that I had to fax my Power of Attorney documents to this company so that I could conduct this business while my brother-in-law was in the hospital.

The second person I am transferred to deems herself helpful in this way:

“I can’t find your Power of Attorney document in my system.”

“That’s okay,” I replied, “because I’m just calling to let you know that my brother-in-law passed away.”

“Well,” she said tartly, “I think you have to call back and speak to customer service about that.”

“Okay,” I said slowly and a bit confused, “but will they take care of this then?”

“Well, I don’t know!” she sputtered, “but your Power of Attorney isn’t any good for dead people.”

Oh my God, did she really say that? Actually, I say that all the time in my lectures where I’m teaching about what you need to do get your affairs in order, but still….really?

“I know,” I told her, “because I’m also the executor.”

“Huh,” she mumbled, “Well, I don’t see any executor papers here in the file.”

“I know that too, he just passed away a week ago,” I said slowly and patiently, or so I thought. ” I just wanted to inform you so that you stop putting money in his checking account.”

“Well, we can’t just do that. Did you call his former employer?”

“Why, yes I did, with no difficulty.”

What she's really doing while talking to me.
What she’s really doing while talking to me.

“Well then,” she said with exasperation, ” they will take care of it.”

“So I DON’T have to call customer service?” I inquired.

“The employer will take care of it,” she said.

“Look, I just want you to note that so you don’t keep putting money into his account. Is that possible?”

“No.”

I didn’t tell her I was closing those accounts. I’m just smiling knowing those checks would be swimming around in the direct deposit atmosphere for who knows how long.

And I did not call customer service.

’cause well………….in these times,

“You Just have to Laugh…………”

©2015 Cathy Sikorski

 

What I won’t do for $62.00

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

My sister and I recently had the pleasure of taking my Mom to renew an acquaintance of her’s from the 1950’s. My Dad was in the military and during that time, my mom made some pretty intense relationships with other military wives. That show “Army Wives” seems to indicate that not much has changed in 50 or 60 years, in that military spouses, especially those who are not in the military themselves, are bound and determined to make good friendships on bases, even if they know they are only short-lived.

So we trek down from Pennsylvania to Washington, D.C. to meet up with these dear people who haven’t  seen my mom since 1955. It was absolutely delightful. Their son was kind enough to bring them to a restaurant in town so that we could spend two or three hours together. Reminiscing for the older people, getting to know them for us, “the kids”, for the son and I were not even born when they knew each other. Nonetheless, as the parents are in their eighties, and we are in our fifties, the topic turned to health, health insurance, and “what do you do?”

As I began to relate my caregiving stories, I told their son, the lawyer, how frustrating it is for me to see the elderly getting ripped off all the time by their own health insurance. And that brought about the tale of the $62.

I have told my mother, mother-in-law, aunts, uncles, disabled brother-in-law, cousins and pretty much anyone who would listen, that JUST BECAUSE YOU GET A BILL FROM A DOCTOR OR MEDICAL PROVIDER, DOESN’T MEAN YOU HAVE TO PAY IT. As you can imagine from the capital letters, this advice often falls on deaf ears. (Like, why would I who practices elder law, medicare law and has been a caregiver for sick people for over 20 years know anything about this?!!) AND, so the unsuspecting relative, friend, client, pays the bill and then brings it to my attention…ever so much later! Of course, this sends me into a tizzy. Yes, I said tizzy. I rant and rave and get on the phone with the offending billing department, which I KNOW, will be receiving proper payment from all the insurance they have and they will owe nothing.

One such scenario went like this:

“Hello?, you sent my mother-in-law a bill, and her insurance has paid you already.”

“One moment please. Do you have the account number? The date of service? Her insurance card number? Her OTHER insurance card number? Her date of birth? Her astrological sign? (okay they didn’t ask for that, but if they did would you really be surprised?)”

“Well, yes I see that she has other insurance, but you will have to get a new bill from her doctor showing this, that and the other thing to clear this up.”

So I call the doctor. And they are very nice, and more than willing to send me a new bill showing this, that and the other thing for proper credit so that I can get my mother-in-law’s $62 returned to her. But the desk clerk leaves me with one thought:

” Good luck getting your mom’s $62 dollars back, that almost never happens.”

“Oh,” I say, “you don’t know me.”

Next week the $62 check comes to my mother in law, who insists on splitting it with me because of the fine legal work she has witnessed. But  here’s the thing. I would do that again and again for $1 for every elderly person who is paying these bills they shouldn’t pay, likely living on a fixed income, and their insurance does, in fact reimburse the doctor, but the patient never sees their money come back to them. Truth be told, I’d probably make a million bucks doing it!

You just gotta’ laugh…. (and fight with insurance companies and medical providers)

Cathy Sikorski