Medicare Supplement Insurance . . . It Can Be Tricky

George, an 85 year old, was surprised when he received a $4000 bill for his pacemaker replacement procedure, after he was told that it would cost him $250.   He’d called his Medicare Advantage plan before the procedure and was told that he would be responsible for a $250 inpatient hospital co-pay.  Unfortunately, the hospital and the doctor’s office did not tell him that his procedure would be done as an outpatient with an overnight stay.  He stayed overnight but since he was never an inpatient, the bill was applied to his $6500 deductible for outpatient services.  

It’s a constant refrain!  You’re a senior, on medicare, you do everything you’re told but somehow you still owe $4000.  Again – these insurance companies DO NOT WATCH OUT FOR SENIORS and make the simplest of “medical procedures” complicated on the non-medical side.  A simple medical procedure mixed with insurance is like a game with no rules.  It doesn’t matter what plan you choose, there is still many a “slip between cup and lip”.  No other industry in the U.S. is allowed to operate this way.  It’s illegal!

This is especially true if you have a Medicare Advantage plan. These plans are less expensive than regular Medicare with a supplement for a reason.  They may add extra benefits, but they are often more complicated to understand. So what do you need to do to avoid surprises or issues? Plan ahead, ask a lot of questions and advocate for yourself, your partner, your family members or call Parent Your parents.  We can do it for you. 

Parent Your Parents is pleased and proud to announce the advent of Ann McGuire, R.N. to our growing group of experts.  Besides being a RN she is also a certified case manager and knows the pitfalls of senior insurance issues.  Please go to our website, ParentYourParents.com to see her photo and biography.  She and I will be collaborating on more articles to assist you with getting through the insurance maze  . . . little things like what to do if you’re sent to the emergency room.

Bottom line:  remember – insurance when going to a clinic or hospital for any procedure can be very tricky.  It’s not because the doctor wants to charge you more, it’s because of the intricacies of how Medicare Advantage plans work.  

TREATMENT OPTIONS

Once a family member becomes ill, we seem to go into a reactive mode instead of proactive mode.   Much of this stems from our avoidance  . . . we just don’t want to face the fact that a loved one is “really” ill.  That is why it’s so important to have a third party option that you trust.

We at Parent Your Parents are fans of Patient Advocates or Health Care Advisors.  These are professionals who advocate for you – the patient and the family.  They will educate you about your issue/illness and discuss your treatment options.  Although some patient advocates are not health care professionals (only certified) we suggest Patient Advocates who are health care professionals.

Often our seniors go to the doctors and are shuttled from test to test (because medicare pays for them) and, depending on the doctor, are told the best “solution”.   Often these solutions require more medication or surgeries and another stay in a hospital or rehab center.  A Patient Advocate can review the records, nurses notes and question the doctor and offer other solutions.

One example, a knee replacement that becomes infected.  In a case like this 90% require a second surgery and an extended course of IV antibiotics.  However, only the surgery must be done in the hospital.  After two days the patient can leave and have in-home care.  Yes, a COMPETENT, aide will be necessary but the physical therapy (PT) and occupational therapy (OT) can be AT HOME.  The doctor has to prescribe the physical therapy and occupational therapy but Medicare pays for most of it.

Seniors are almost always told that hospital and rehab are the only option  What they’re not told is their cognitive function will most likely be impaired during their stay.   Imagine, those machines going off in the middle of he night,  constant noise, people walking in and out – who wouldn’t be disoriented. The bad news is upon release from the hospital the cognitive impairment stays — they will get better slowly but rarely reach the pre-hospital cognitive function.

To most of us, our home is our sanctuary.  We’re in our environment with people we know.   Yes, you’ll need competent in-home care, usually for 24 hours for the first few days but there are excellent services who provide this – you simply need to know who they are (we at PYP do).

So here is the bottom line when something “medically bad” happens:

  • Always search for alternative answers (Patient Advocates will assist)
  • Question the Diagnosis (Doctors are only human and you’re one of many patients)
  • Make a Hospital the stay of last resort
  • Remember In-Home Physical Therapy and Occupational Therapy is available and Medicare pays for most of it
  • And for the first few days 24 In-Home Care is almost always a must

If you have further questions, thoughts or criticisms feel free to reach out – hfrancesr@parentyourparents.com

Emergency Preparedness for Seniors

The article below was published by Nursing Home Law News.  It was written by Jonathoan Rosenfeld who is the publisher and an attorney.  The best part of this article is that a Girl Scout, Samantha, who is working for her ‘Emergency Preparedness Badge’ found this article and our website and thought it would be a great addition for our resource page.  We couldn’t agree more!!!  We’re publishing it in our blog page today but adding it to our resource page next month.  Thank you, Samantha!

IN AN EMERGENCY, staying safe often depends on having some type of preparedness plan in place. This is particularly true for senior citizens. Whether a person is in a senior care facility or living independently at home, clear steps should be taken to prepare for potential emergencies and their aftermath. When elderly individuals live in a nursing home, the responsibility for creating and implementing these plans is in the hands of the facility’s administration and staff. Seniors who live on their own, however, often must create a preparedness plan for themselves.

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SENIORS SHOULD NEVER SUFFER . . . BUT THEY DO

This is an editorial to the Miami Herald written by H. Frances Reaves, Esq., President of Parent Your Parents,  in October of 2017.  This was written after Hurricane Harvey and Irma and the mirror placed on Senior Services. As we suffer through a very cold winter these words are still prophetic.

IF YOU HAVEN’T SEEN the video of the residents of a nursing home in Houston, Texas sitting in waist high water simply search “video of seniors in waist high water” in your browser – the You Tube video comes right up.   School children were evacuated, families were evacuated and who was left behind  . . . seniors.  Two weeks later, in the aftermath of Irma, 14 seniors die from overheating in a Broward County Nursing Home.

If these seniors had been children the outcry would have been much louder and punishment swifter.  An excellent example is the most recent earthquake in Mexico.  The school caved in on top of 24 children and four adults.  The volunteer rescuers were there within minutes and the TV crews transmitted  the entire search and rescue for more than three days.  That would not be the case if this had been a senior citizens facility.

Fariola Santiago wrote in her September 24th column that “the elderly are like children, frail, unable to care for themselves, and vulnerable to abuse and negligence.  Those who don’t have money or advocates and require round-the-clock care end up in places with deplorable conditions  . . .”  I agree with Ms. Santiago regarding the elderly but disagree that all nursing homes have deplorable conditions.  We also need to remember that, with the exception of one “lonely soul,” everyone had a family  . . . and the family did not take them from the ‘deplorable home’ even after they knew about the power failure.

Baby Boomers, Gen Xers and Millennials beware — you, too will be a senior!  Seniors, are an older version of who we are today. We espouse the sentiment that, “I only want to live a long life if I have a quality of life” but legally we don’t have a choice once our mind collapses.

What we don’t discuss is that dementia does not take away your intellect, mental pain or physical pain.  Dementia takes away the ability to communicate effectively.  It also absconds with your memory – which allows we the children to believe that with memory loss there is a loss of all senses.  That is not the case.  The 14 elders who died felt pain and the first to die truly suffered because they did not have the benefit of hospice care.

No doubt, the staff at this nefarious nursing home was negligent, incompetent and uncaring and they were allowed to function as “caretakers” for years.  It took a hurricane and power outage to bring it to light. Had this been a daycare center the negligence would not have been allowed to continue.

As the President of a company who advocates for seniors, finds resources, counsels families and assists in medicaid preparations, my experience shows that most of us face living in a medicaid facility.  Unless you have a healthy pension or half a million dollars you will not have the money for dementia care in a private facility.  Today that runs between six to seven thousand dollars a month.  If you qualify for medicaid, nursing homes run about $700.00 and  medicaid picking up the balance.

We must look in the mirror!  let’s begin the process of treating our elderly loved ones as our children.  Treat them as you treat those around you.  Hold the Assisted Living Centers and Medicaid Facilities accountable and — START SAVING!!