Tag Archives: Health

Never call an ambulance if you’re old…..Part 2

I think I have spent about $5,000  ( at least in legal time and photocopying) trying  NOT to pay an ambulance bill. I began this tale as one of my first blogs, Do you really need an Ambulance? I think not. I related that my dear 95 year-old mother-in-law was found in pain in her assisted living facility, and the staff correctly called an ambulance. Her pain was evident, so even though she suffered from dementia, which was documented, the ambulance drivers decided to take her to the hospital.

For over a year now, I have been fighting with Medicare to pay this bill. I have told the Ambulance Company, I will not pay this bill, as there is no way my mother-in-law could have made the decision to go to the hospital, let alone  CALL for an ambulance. I do not wish to leave these hard working emergency first responders without pay. However, there has to be some manner in which they can support the patient when the first responders make a medical call, that requires an ambulance.

My mother-in-law does not drive. She has never driven. She has never had a car. In an assisted living facility, she has no transportation to go anywhere without it being directed by someone else. The facility is also doing the right thing by calling for an ambulance for a client who seems to need medical help.

Okay, so we’ve established that everyone who actually PARTICIPATED in this trip to the hospital made a rational and correct decision. The only people who don’t agree with this is Medicare and it’s not even Medicare. It’s a company called CMS, an independent contractor, who assesses whether the claim should be paid. So I send 22 pages of documentation with a letter of explanation telling this independent contractor why they should pay this bill.

The first denial is because this darling old lady really didn’t need to go to the hospital. They found nothing wrong with her and sent her home. Yep…..that’s absolutely true. But, I persist with an appeal.

The SECOND DENIAL is because I have NO AUTHORITY to appeal. I call to clarify this.

” If you would like to leave a message, please leave the appeal number, the claimant’s social security number, the date of service and the provider for which you are appealing. Please leave a phone number and we will return your call.”


They do call me back, and I explain that I am holding in my hand the appointment of representative form that gives me authority to talk to them AND to APPEAL.

“O well, sometimes Medicare doesn’t send us all the paper work in the file so you need to send it to us again.”

I grind my teeth. Call the ambulance company AGAIN to reply to the bill they have sent ME again, and tell them I am still appealing.

The THIRD DENIAL comes because they still didn’t get my paper work. I call them again and they say….”oops”….and ask me to send it again. I ask the representative to explain to me how I will know if they get it…she says:

“Well you might get a notice that we received it…..wait, no, no I don’t think you will.”

Yesterday, I got the ambulance collection agency notice. They are going to sue my mother-in-law, which I kind of want to let them, because she died.

But I leave a message for the independent contractor, who calls me when I am in a meeting and can’t answer the phone. AND THE MESSAGE IS:

“This appeal was dismissed twice for failure to have the proper paper work to authorize you to appeal.”

I am not fing kidding. I’m not.

I was just going to pay the $797.20 bill. I mean they are just wearing me down to the nub. But I decided to give it one more try. I’m waiting for the return call.

To be continued……

And you really, really do…….

Just have to laugh….

Cathy Sikorski

“A girl should be two things: Classy and Fabulous” Coco Chanel

My Auntie J from Australia is  fashion plate.  At 90 years of age and barely 90 pounds, she is a wisp of a girl, who never looks anything but chic. Even her ‘sweat suits’ are more along the lines of Juicy Couture than what I wear to the gym. When I met her almost 30 years ago, she was never without a matching handbag for her beautiful and expensive shoes.  In my ignorance of thinking back then(before I realized now how young 60 really is)that this was an ‘old lady’, I was also thinking, “damn, she’s a fine old gal with great taste!”

Up until last week when we had to take her to the hospital for the first time in 25 years, she had her hair done (as a blonde…..never gray) every week, and her nails done as well. She was an extraordinary example of fine grooming, beauty, grace, and the true benefit  of “just a little lipstick, never hurts.”

So after ten days in the hospital, where she was really very, very seriously ill, we took her yesterday to a rehabilitation center. For very complex reasons, she went to a center two hours away. The ambulance drivers were two young adorable men, who treated her like their very own dear grandmother. By the time we met up with them at the end of the trip, she was holding their hands and kissing them goodbye.

She had been very concerned about the fact that she was transported in a hospital gown, but I reassured her that we would take her clothes and pretty pink nightgowns to the rehabilitation center, so she could be properly dressed there.

My husband and I have been very concerned for her health during this time and my mom, a former nurse has been right by our side the whole way, comforting, advising and just being a strong shoulder. But because my mom was a white uniform, starched hat nurse of the 40’s and 50’s, she has looked askance every day at the ‘sloppy’ nurses, aides, and technicians who have come to care for Aunt J.

“Look at that,” my mom would say.

“What?”, I ‘d reply, expecting an inept stick of the needle to draw blood, or a hospital meal that was not up to snuff.

“Look at how that nurse’s trousers are dragging on the floor, and no one has their hair up in a bun or a pony tail.”

“Well,” I say, “I guess we just have to overlook certain things when we are happy with her care.”

Of course, now I’M thinking something is terribly wrong here. And then I realize that my mom has much higher standards for dress and presentation than I, or the world, does any more.

So knowing Aunt J and her true art of dressing and personal presentation, I start to wonder if this is bothering her too. She never says anything and the following incident makes me realize that for Aunt J, it isn’t about how people look to her, it’s about how she presents herself to the world.

We get to the rehab center, and one of the last things I want to make sure of, is that Aunt J knows how to push the red button to call for help. With my mother-in-law, when she moved to assisted living, and with many stories from friends about their elders, I KNOW that this ‘pushing the button for help’ thing is somehow difficult for them to comprehend.

So I disconnect the button from the clips on the side of her bed, and make sure the cord is long enough so she can have the button at her fingertips. This particular button is like a tube with a bright red button at the top.  So you would hold it in your hand, curl your fingers around the tube, and push on the bright red circle at the top of the tube with your thumb. That would be how most people would use it, and probably the easiest way.

I bring the tube close to her, and I pantomime what I want her to learn…pushing the button. And I’m telling her, “if you need help, you push this red button.” I put the tube in her hands and tell her:

“Now you practice. If you need any help, I want you to PUSH THE BUTTON.” And again, I show her what to do.

My darling, beautiful Aunt J, shakes her head in the affirmative, looks me straight in the eye with her beautiful blue-green eyes, looks at the tube that I have placed in her hand with the bright red button on top, takes her other hand, rubs the top with her index finger and promptly ‘applies’ the beautiful shade of red lipstick I have given her to her luscious lips. Classy and Fabulous.

You just have to laugh………………….

Cathy Sikorski

When UTI does NOT mean Understanding The Infirm……

I have a dear friend who suffers from a brain injury. We are writing something to share with the world soon, a blog, a play, a memoir, so I don’t put that here (and yes, I have another person in my caregiving queue)but I asked her if I could share this one little tidbit from this week.

So she has to go to the doctor for a UTI (urinary tract infection). When you reach our age, you know when you have a UTI and in the OLD days your doctor trusted you and you could just call and tell them that you have a UTI and they would call in a prescription for an antibiotic. This really doesn’t happen now, so imagine her surprise at this conversation:

“Hello. Dr.’s office? I need an appointment because I have a UTI.”

“Ok,” says the receptionist, “which doctor do you see?”

“I see Dr. S.”

“Ok,” what pharmacy do you use?”

“I use Walgreens on Main Street.”

“Ok, very good.”

And, after getting her name and address and birthdate, the receptionist hangs up. So………………..what would you think? You would think that they talked to your doctor and called in a prescription to Walgreens on Main Street, right?

My friend goes to Walgreens on Main Street. Nope, no prescription. And the pharmacist checks with other Walgreens. Nope, no prescription. So my friend calls the doctor’s office.

“Ummmm, I called earlier because I have a UTI and the receptionist took my name and pharmacy and there is no prescription here.”

“Oh, well, you have to come in and see the doctor, we can’t just send out prescriptions without and appointment.”

“Well,” my friend says, ” since I am disabled, I don’t drive, and I have to walk or take the bus everywhere, it would have been nice if your receptionist would have made an appointment for me rather than sending me to Walgreens on Main Street without that vital information.”

Silence. Dead Silence.

“Can I make an appointment for you?” Says this receptionist. “Can you come in now?”

“Not unless you’re coming in your car to get me,” says my friend. I need to get to the bus and then get to your office. So let’s make that appointment for tomorrow.”

She goes to the doctor ‘on the morrow’ and gets the prescription called in, with an additional prescription, but not before this conversation with the PA (physician’s assistant—and BTW I LOVE PA’s I think they have made the world ever so much better MOST of the time):

My friend says to the PA: “So I have had this for about a week, but I worry whenever I get any kind of infection because my brain surgeon said infection can be very dangerous for me, as I am already compromised.”

“Well,” says the PA, “I highly doubt that a UTI would get to your brain. He was certainly being overly cautious.”

I so wish I had been there. I would have said, “Look, you can be overly cautious with your brain, but I have 40 titanium coils in my head to stop a brain bleed and I have miraculously survived a subdural hematoma that causes permanent problems……so I AND MY BRAIN SURGEON choose not to be overly cautious.”

Next installment…..Walgreens on Main Street….

You just have to laugh…….

Cathy Sikorski

A Waitress Contributes

So my girlfriend and I go out for lunch.  I ask my friend how her elderly parents are doing, on the other side of the state, and she relates how they are in the midst of considering assisted living. So we go back and forth for a few minutes talking about the possibilities, and what I know both in my experience with caregiving and with Elder Law. The waitress stops by to take our order and says,

“Hi ladies! I don’t mean to intrude but I heard your conversation and wanted to tell you about my  dad.”

“Sure, I said. What’s going on with him?”

“Well, he’s in a rehab center now, but we just moved him from the county home to a private facility for which he is paying $6500.00 a month. He doesn’t know that but we decided to put him there because he is getting excellent care.”

“Why did he leave the county home?” , I asked her.

“Well, his insurance and the medical team there said that he has reached a point, medically where he was good enough to go home. And basically, we moved him directly from the county home to hospice care.”

” Wait, WHAT? I’m sorry. What is your name?” I asked her.

“It’s Donna.”

“Donna, I am so happy to meet you. I know how hard it is to be a caregiver. So let me get this straight. Your Dad is allegedly so healthy, that he no longer needs to be in the county nursing facility. But the minute you moved him to the new facility, that facility put him in the hospice program, which means your Dad is seriously ill. ”

“And”, said this hard working, generous soul of a woman, “my Dad is a veteran and served during the war. But he is not entitled to veteran’s benefits because he has too much in assets. So, we will blow through his money, if we have to. We will make sure he gets the absolute best of care, until the money runs out, or gets as close as we need to get him veteran’s benefits.”

I happen to be going to a seminar this week that addresses this exact problem. So if I find out anything to help her, I will seek her out and tell her. But even though the veteran’s issue may be true. The thing that really frosts me…the thing that can’t possibly make any sense…is that how can the county home and the insurance company look at this sick elderly man, a veteran for crying out loud, and say: “Sure, he’s ready to go home!” And so the family, who KNOW their Dad and know that he needs a truly high level of good care,  place him in an excellent facility, and are instantly told to put him in hospice care. Do these people not know what the word, hospice, means. It means this person is really, really, really sick….and NEEDS care.

Not really a laughing matter, but absurdity abounds in this caregiving world. Thanks, Donna, for allowing me to post  your story! I’m still looking for anything that might help you.

Cathy Sikorski

Hi Ho Hi Ho, it’s off to the pharmacy we go…..

Normally my time would be spent talking about my elder care experiences and the craziness that is insurance, clothing, finances, people, food, and anything else in an ‘ordinary’ day.  But caregiving, as I continue to find out, runs the gamut across all ages and time…for the caregiver, that is.

Yesterday, my 21 year-old daughter woke up with a pain in her eye.

“Mom, what does a scratched cornea feel like?”

“Well,” I said, “let me put it this way. I would rather go into labor 10 times with 10 babies 10 days in a row, than EVER have to feel a scratched cornea again.”

“Well, my eye hurts every time I close it, so I think I might have that.”

Since she wasn’t writhing on the ground in pain, screaming for an emergency room or an epidural, even though not pregnant, I was pretty sure it wasn’t a scratched cornea. But since she was leaving for college in 4 days, and I didn’t want to drive 5 hours in 5 days when she called me writhing in pain, I decided we should see if the eye doctor could squeeze us in. Of course, as with every one of my emergencies…this was a FRIDAY, so if not taken care of today, we would be in the emergency room tomorrow. Good, or tired, or worn-down caregivers learn to hate Friday NOT Monday.

After a thorough eye exam, the doctor tells us she has GPC. Weirdly, that’s a new one on me. I was pretty sure I could sit for a Medical Boards Exam by now. It’s a form of conjunctivitis that is not contagious, but must be medicated 5 times a day, then 4 times a day, etc. for a month. And you really should wear your glasses not your contacts because the medicine has to be put in without contact lenses in your eyes for at least 15 minutes each time. Well, you might as well have told this 21 year-old college girl to get a Cyclops eye, a Freddy Kruger mask and a mermaid tail to wear back to college. She does NOT have time for ugliness or inconvenience. Tough s***t, says mummy.

Now, before we even leave for the two prescriptions she must get in her EYES (yup, it’s in both eyes, the other done just didn’t hurt yet), we beg the eye doctor to send in our claim to insurance. We don’t have vision coverage, but this is a medical problem. So we will see. I know if I had taken her to the emergency room or the regular doctor, this would be covered. Call me crazy, but my doctor does not have all those zippity-do-dah eye machines to look into my daughter’s eyes and see what’s going on there.  And I asked the doctor if we could see it ourselves, and she said, “not unless you have a microscope.” So I will keep you good readers informed about THAT insurance result. Can hardly wait.

After we leave, we need to go see “L” my brother-in-law who has MS and I care for, which, was the ONLY thing I had to do today. HAHAHA. But first I need to stop and get him a few things on his list. I need to call his caregivers to give me an extra hour tomorrow to dress him for a family party. I need to call my sister, who is picking him up. And, when I finally get to see him, I find that we need to change his password for his retirement fund and BTW his computer has crashed.

SO THEN, I finally get to the pharmacy, where, coincidentally they know me by sight, don’t even ask for my name and go right for the drugs that have been ordered for me or any family member.

“Sorry, Cathy” says Rich (yea me and the pharmy are on a first name basis), but I only have one of your scripts.”

He sees my face fall…because remember, the college girl is going back to far, far away college in 4 days.

“BUT,” he quickly adds, cause he has also seen me melt down on just such occasions as this before….because there have been MANY of them, ” you can go to the pharmacy down the road and I’ve already put your order in there, where it’s been filled.”

“Yay!, and thanks,” I say, so kindly and enthusiastic.

I drive the extra 20 minutes, go into the NEXT pharmacy, and enter a fiasco with another poor customer whose insurance company randomly cancels her son’s much  needed insurance every  90 days. I feel so bad I want to pay the $70 for her medicine and I think I would have, but the pharmacist assures her she will be reimbursed, if she just pays for it now and comes back after a few phone calls. (More like 927 phone calls in  my experience).


You just have to laugh…….

Cathy Sikorski

About that Invitation……

Okay, I know you think you are doing a kind and generous thing by inviting my wonderful disabled L to your event. But here’s the thing, you are more than willing to put out that invitation and I will even go so far as to say, that you are doing it with the most generous of hearts and spirit. You know that this person you love is severely disabled, but you want to include them to show your love and acceptance. But the truth of the matter is, you really give very little thought to what an invitation means to the caregiver.

It is not for one minute that the caregiver does not want their charge included. It is extremely unlikely that the caregiver does not love this person as much, if not more than you do.After all, they are the caregiver.  But, but, but…….really…….what will this invitation entail? Will the caregiver need to acquire appropriate clothing so as not to embarrass you or the loved one on this special occasion of yours? Will the loved one’s schedule of care, bathing, medicine, toileting, assistance for dressing, undressing, getting out of bed, getting into bed, eating, drinking or sleeping work with your event? Have you considered in any way, how will my loved one get there? Does it require special transport? Who will make that happen? Who will pay for that? Have I tried to put any of that into place, or am I just sending out this invitation?  Am I also inviting the caregiver? So do THEY have time to get ready, get their loved one ready, get to your event? Is the event the appropriate venue for my disabled loved one? Will they be able to stay for any length of time? Will the caregiver just barely get there and then have to leave because the venue doesn’t work, there aren’t appropriate toilet facilities. it’s too hot, it’s too cold, there’s no food for them?????? And that, my friends, is the short list.

You see what I mean? In your zeal to be inclusive and loving, you may, in fact, be setting up the caregiver for an over-the-top horror show. And often, the caregiver loves you too and doesn’t want to disappoint you OR the person they so desperately CARE for. And more often than not, the one who is being cared for, wants to go. Of course they do. They want to get out. They want to engage with old friends and family.They also do not really want to consider the ups and downs of turning down an invitation. Likely because, all those kind and well meaning people who have sent out the invitation, never or hardly ever make the effort to come see or spend time with the disabled loved one. Life is busy, life is hard…..I know…..I’ll invite them to our special party!!!! That way we can see them, spend time with them and (God forgive me, feel less guilty, perhaps?)

Are you really thinking this through? Could you possibly change that invite to a special birthday, wedding, anniversary or graduation, to a special visit where you go see your disabled loved one. Take them a special meal, take them out for dinner, take a load off the caregiver.

Perhaps it’s not an invitation that is so welcome, as much as it is a two-by-four upside the head that says, “Duh…..maybe I have a better idea…..”

Cathy Sikorski

A case for joint bank accounts

I may have sealed my own fate by allowing myself to be a lawyer and a caregiver. People really like that stuff. One way or another, they are going to find a use for me. My sister is now in the process of settling her aunt’s estate and she needs a lawyer who understands estates and the legal ramifications of former caregiving. She took care of this Aunt for many years. Both because she’s her Aunt and because the Aunt successfully alienated every single person in her life. My sister is now left with a miniscule estate to administer to pay back the state where her aunt had nursing home assistance and get all her other bills taken care of. Sounds easy, right? Nope, this Aunt left “everything” to my sister AND four other nieces and nephews in a foreign country. Swell. Thanks. Because NOW, rather than wrap this up easily, which a joint bank account would have accomplished, it will require a small mountain of paper work to satisfy the bank, and the state, that no one is getting anything except those who are owed. But Aunt pain-in-the- neck didn’t want a joint bank account, which of course, is absolutely her right. But oh the trouble that now creates.  And of course, corresponding with those in the foreign country that they are getting nothing and would they please acknowledge that so that we can all go on with our lives. Hmmmm.  Wonder how that will work out?

How to ask for help

I haven’t really mastered the fine art of asking for help, which is probably why so many people keep ASKING ME FOR HELP.  After a luscious week of time with my daughters both home from far away, and lots of time with visiting family over the 4th of July holiday, I was pleasantly exhausted and ready for the messy structure of my life. My 90  year old Aunt came to stay with us while all the family was here, and my sainted 84 year-old mother kept Aunt J at her house until I had more room. During that time Aunt J developed an indeterminate pain to go along with the continuing pain from her shingles that I discovered on her last visit three months ago. Ultimately, my Mom determined that a walker was in order, and it seems to have done the trick to keep Aunt J upright, balanced, and less whiney(also wine seems to help). We did a mani-pedi day for all the ladies as a treat, and now I pay the price. This morning, as I try to get back to work, laundry, phone calls, grocery shopping, appointment-making, etc., Aunt J comes downstairs with a finger the size of a sausage. WHAT??? The only thing we can think of is that she got nicked at the salon and has an infection. She was treating it herself, apparently, with Band-Aids and Neosporin. So off to the clinic we go, the walker, the Aunt, and the sausage finger. The very sweet doctor(who happened to be the shingles doctor as well) lances her finger, squeezes out all “the badness” as Aunt J calls it, and puts on a Band-Aid and Neosporin and gives us a prescription for antibiotics. But wait my cell phone is ringing and the number is eerily familiar……




“This is your brother-in-law’s caregiver. We are pretty sure he has a urinary tract infection”,

Yup…. you just gotta laugh.