Tag Archives: Insurance

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

With Facebook Friends like this…Who Needs Enemies?

Caregivers, Humor, , , , , , , , , , , ,

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

 

Sometimes You Just Need a Lion on Your Side…….

Caregivers, Humor, , , , , , ,

I called the hospital today. Well, more accurately, I called the hospital billing department. The billing department is no longer in the hospital. The hospital is in Pennsylvania, where I live, and where my loved ones go to the hospital when they have a problem, medically.

The billing department is in Tennessee, where nobody, who goes to my hospital, lives or goes to if they have a problem medically or otherwise. Okay, maybe that ‘s not true, maybe some people go to Tennessee if they have a problem with say, country music, and want to see if it’s them or the music.

By putting the ‘billing department’ in Tennessee, it prevents all of us in Pennsylvania from actually going to the billing department to talk about a problem. That way no one has to discuss these problems face-to-face. So much easier, said no one, ever.

I called Tennessee today, and although the gentlemen was very nice, the problem was apparently unsolvable.

“I want to know if this bill, which started out at $4500 and is now magically down to $500 has been paid? ” I queried, for the third time in three months.

“Well, ma’am let me see. Now before I answer that question, even though you’ve given me the account number, can you give me the address on the bill, the date of birth of the patient, the date of the bill, the services rendered, the patient’s blood type and the name of their cat?” he asked ever so politely.

Okay, he didn’t ask for the blood type or the cat, but why not? My question is, why in heaven’s name do you put an account number on the bill if it means absolutely nothing in terms of information? Do you make more money by keeping me on the phone? Are you tracing the call just to make sure I’m not in Tennessee, but that I stayed in Pennsylvania where I belong?

We do-si-do all around the information, until we’re both exhausted and wish we had taken more square-dancing lessons, and finally, he says:

“Please ignore that bill ma’am the insurance company has agreed to review it.”

“Okay, but I have an estate to settle, so can I assume that the bill will be no more than the $500 you currently are requesting?”

“No, you cannot.”

Here’s where I want to find a cat, maybe a tiger or a lion, and release it into the wilds of Tennessee with the scent of this insurance company on its nose like a barrel of catnip.

“Um……….why would that be?”

“Well, what if the insurance company decides to take back all the payments they already made? Then the bill would be more.”

“Why would they do that?” I asked, “Medicare paid this over a year ago and this has been your fault for not properly submitting the balance to the other Medigap insurance carrier.”

“Well,” he replied, “we don’t know what they will do.”

‘Cause you don’t know what you’re doing……that’s really what I wanted to say.

But since he told me to ignore the bill, I’m gonna’ do just that. Probably forever.

“You Just have to Laugh…..”

©Cathy Sikorski 2016

 

Want a Laugh? Call the VA……

Humor, Uncategorized, , , , , , ,

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……

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

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

Best Notify My Next of Kin…This Wheel Shall Explode….Absolutley Fabulous

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

The frustration level of caregiving is equal to the dropping temperatures here on the East Coast, which is at a 100 year low.  Pretty sure that’s true.

Finally after spending 6 months in rehab, my brother-in-law was finally home, healthy and enjoying his meals in the dining room with his best pals. Then the flu hit his facility. On Christmas.  But five days in the hospital with the flu, double pneumonia and a urinary tract infection did not keep  him down. Home on New Year’s Eve, he was ready to get back to his normal life.

When he, his neighbors and his caregivers all noticed that he was precariously listing to the right, they called me.

Now this wheelchair has been a problem for several months. A new set of footrests were installed and ever since then, the wheels get stripped. After the second time this happened, I told the repair people to really look at the problem.  The footrests were major culprits and needed a good talking to.

Here we were again only 60 days after new wheels were put on the chair. My brother-in-law looked like he was practicing for a circus act, as he sped down the hallway with his hair blowing in the breeze at a 45 degree angle.

When his caregivers called me, on Sunday, I was firmly ensconced in a charming little Italian restaurant 150 miles away in NYC. Of course, it’s adorable that they think I can actually fix the wheelchair.  I would have to have extra wheels, a special screwdriver, and actual mechanical knowledge. No wonder I have a God complex.

Monday, bright and early I call for repair assistance. I beg. I plead. I offer candy, money and my first born, whatever it takes to get this chair fixed ASAP, since he just got back to a semblance of a real life. What usually requires two weeks, will take two days. Okay, we can live with that.

Two days later, I arrive at my brother-in-law’s apartment for the 10:30 AM appointment. I’m psyched. Chair will be fixed. Man can get in chair and have meals with friends, all will be well in the universe.

10:30 comes and goes.

11:00 comes and goes.

“Hello, wheelchair repair guy, where are you?”

“He’s just a bit late,” they tell me.

11:30 his caregivers arrive to get him dressed to gently place him in his newly fixed chair. Except that it’s not.

12:00 comes and goes.

I have to call again. Why would they call me? I’ve only called them 10 times in the last 48 hours. It’s not like they have my phone number or know that I am waiting for them.

“Hello, wheelchair repair guy, where are you?”

“He got caught up at his last job, he will be there as his last appointment of the day. Sorry, i hope that’s okay.”

Sure. I only have to now order his meals to be delivered to his room, if it’s not too late. I need to reschedule all the caregivers because their duties will now change, since he is in bed and can’t get in his chair. I will have to go to the dining room and tell his dining buddies that they don’t have to set up his place, his tea, and his special condiments like they do every day because they are kind and amazing. But sure, no problem, you just show up when it works for you.

What I say is, “okay, just get it fixed, today.”

Miracle of miracles, I come back early in the evening to find BOTH wheels repaired, the foot rests changed and the chair ready to go. Too late to get my brother-in-law in his chair. But he says, “hallelujah” when I tell him he will be out and about starting with breakfast tomorrow.

On my way to a business appointment the next morning, I’m feeling quite smug as I know my brother-in-law is already at breakfast and I got the chair fixed in 2 days!

My phone rings. I answer with a happy lilt in my voice.

“Hello?”

“Hi Cathy? This is the caregivers. Larry doesn’t feel well. He refuses to get in his chair. He has a temp and should probably go to the ER.”

You just have to Laugh………….

©2015 CathySikorski

Bahamas or Disability? I’ll take both….

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

If I could invent an insurance company manual that would be 101 things NOT to do at an insurance company, I think I might have all their training contracts.

Out of the blue, my brother-in-law receives this letter from John Hancock (see A discussion with John Hancock) stating that he has a bit of a long term disability benefit coming to him. He would have had a huge benefit, but back before he began to ask for help and my Mom and I realized he was going down the tubes fast, he would just let his mail pile up. This resulted in a Superfund clean up of his papers and mail when he was cut off from all disability payments. That’s when I ultimately found a myriad of uncashed checks, uncompleted forms for benefits, and lots of other important matters literally brushed under the table.

I plowed through everything and re-instated his disability benefits, paid all his bills, eventually got 7 years of back taxes completed and found something like $9,000 in unclaimed property from the state.

But I truly never saw any documents from John Hancock. So when this letter came saying that he lost his benefits for failure to pay his premiums seven years ago, I just had to take that one on the chin. It was “B.C.”–before Cathy.

Yet still there was a tiny stipend that was guaranteed by the company. All he had to do was apply.

I was finally allowed to apply once he came home from the hospital. I looked over the application and put it on my “to do” pile for the end of the week.

The next day I received another missive from John Hancock:

“We received your request to reinstate long term care insurance. Please fill out the following forms and we will process your request in a timely manner.”

The forms were 9 pages long, asking for medical information, employment information and if you had ever been disabled.

I was pretty certain that my brother-in-law who has had Multiple Sclerosis for over 15 years, has been wheelchair bound for almost 3 years, and has caregivers 4 times a day to bathe, dress and give him his meds, would not qualify for reinstatement of long term care INSURANCE.

Oh, if you only knew how tempted I was to fill out those forms and have someone spin their wheels on this absurd ‘request’.

But I did the right thing and called the 800 number on the letter:

“CONGRATULATIONS! YOU HAVE WON A CRUISE TO THE BAHAMAS! AND FOR CALLING TODAY, YOU WILL ALSO WIN THREE NIGHTS IN A RESORT OF YOUR CHOICE!”

I obviously  misdialed, so I checked the number and dialed again very carefully:

“CONGRATULATIONS! YOU HAVE WON A CRUISE TO THE BAHAMAS! AND FOR CALLING TODAY, YOU WILL ALSO WIN THREE NIGHTS IN A RESORT OF YOUR CHOICE!”

So apparently with John Hancock, you win a prize for being disabled.

I scanned the nine page document to see if there was a different phone number and there it was. The real John Hancock began with 888 not 800 as in their cover letter. I pondered how many long term disabled people were on their way to the Bahamas just knowing their disability checks would be there when they got back.

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

Related articles

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

A Waitress Contributes

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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