Caregiver Hints

For me, there wasn’t much of a question of who would pay for my Mother’s care. Once her assets were extinguished, as the only child it was up to me to foot the bill for anything not covered by insurance, Social Security, or Medicare. In larger families, however, the issue may arise as to who is responsible and for what?

The following CNN article discusses this question and the rising need to find solutions to the expanding issue of healthcare for the aged. Even though it not a popular subject, families should discuss the issue as a group before they are in the middle of dealing with it. Choosing who will provide hands-on care, if any, or financial assistance early could prevent a lot of fighting and bickering later. Also, as people get older, they should take the initiative to have a say in their care by planning ahead and discussing their wishes with the family.

CNN - Who should pay for mom and dad’s care?

One lesson I learned the hard way, was that you need to stay up to date with all the official mail you get. Once you start managing the funds, insurance, and health care of someone, you can expect your inflow of mail to at least quadruple, not counting the junk mail you will receive.

What I found out is that the envelopes that contain checks for overpayments or refunds from insurance, look exactly like the ones that contain the standard statement of services. So, while you may be tempted to let some of these go unopened, you are much better off opening everything that you receive right away, and taking a quick glance at it to confirm what it is. Then if you have to put off dealing with it, at least you will know where you stand.

Tags: organization, mail, insurance

In a previous post I mentioned the importance of recording details such a doctors’ contact info, medications, insurance information, among other data in a notebook that could be referenced. If you are doing a lot of the communication such as bill paying and arranging appointments, it can be really helpful to keep ongoing details about who you talked to and what happened, or what was said. This was incredibly important when I was taking care of my Mom’s finances, appointments, and assets. If I had not documented these interactions and discussions, I would have easily lost track of who said what, and whether I was waiting for additional information. I think the most trouble I had was with bills. Since I would frequently have to get people to resubmit charges to Medicare or insurance, or call the insurance companies to see what was happening, I would occasionally loose track of what bills I should be paying, and which were waiting for resubmission. The problem is that the accounting departments just keep sending invoices regardless of whether they are waiting for payment from elsewhere. Unless you take notes and stay on top of it, it is really hard to be sure what you really owe, and to whom. Naturally, you are entitled to get a refund if you AND the insurance company pay for the same thing, but that can get even messier.

The simplest way to take notes is just to use a small notebook. I preferred a size around 5 in. by 8 in. Small enough to easy pack or carry, but big enough to hold a lot of quick notes. This was also good for taking notes at the doctor’s office when I went with my Mother. Since my Mom would have trouble remembering the details of her doctor visits, it was best for me to take the time to go with her and find out from the doctor what was going on. Further discussion of this will be carried over into another posting.

In addition to the notebook, I used a computer program to track bill payments and phone calls. Sometimes I would transcribe information form the notebook into the program for later reference. Since I use a Macintosh computer, i used the program Circus Ponies Notebook. This program is great because it allows to to enter and import all kinds of data, create checklists, and best of all it automatically creates a set of index pages for your information for quick look-up. I am searching for a similar program that runs on Windows to recommend to PC users. When I do I’ll update this post. It has lots of other nice features which you can read about on their website. I am hoping to create a Notebook template to use with the program that will help get you started organizing your data. It will be available for download sometime in the future.

The Harriet Carter catalog is often a good place to find helpful care items.

One I saw recently is a MUST HAVE. The “What my Family should know” notebook is a handy repository for all that important information you will need to know if a loved one becomes too ill to take care of their affairs, and it’s only $10. My Mother didn’t share anything about her health or finances unless it was absolutely necessary, and when she began to get sick, I had to sort through piles of papers and disorganized folders to find out what I needed to take care of everything. There was a lot she didn’t even remember, like the insurance policy she had been paying on for years that expired about a year after I found the documentation. That would have really helped with the funeral expenses.

Don’t wait until your parents, or family, has already gotten ill, you may miss something. Get one of these notebooks and start meeting to write down all this handy info and keep it is a safe place…a safe-deposit box even. And make sure it gets updated!

Medicare Advantage plans have come on the scene within the last 2-3 years to help deal with the immense overhead of Medicare billing in the US, at least as I understand it. My past experience with Medicare is that they were often backlogged, meaning slow to pay bills, and dealing with them to resolve billing issues was often an exercise in frustration. Some medical offices would even refuse to bill Medicare, leaving the patient to do this, because the cost of delayed payments and dealing with them was too costly for smaller offices. In other cases, the offices would send the benefit claims, but require up-front payment of bills, and then instruct Medicare to send you (the patient or bill payer) a check for the amount covered. Larger medical facilities usually don’t have a problem, but if there is a dispute, the patient generally has to call the Medicare offices to resolve it. There are a number of Pros and Cons to these plans, so generally you will have to review the issues and see what decision is best for you. Unfortunately, in my opinion, this is not as simple as you might hope.

Blue Cross/Blue Shield (or in my case Blue Cross of California) was one of the first companies to instate a Medicare Advantage (or replacement) policy*. When first introducing the policy, Blue Cross set up seminars that people could attend free of charge, to get an explanation of the policy benefits, and to ask questions. Representatives would also help you fill out forms and get additional information. As far as I know, they are still doing this, so best to check out their website at http://bluecross.com/ or check your local area for an office you can call for more information. At the time I was investigating (about 2 years ago), they were not offering the Medicare Advantage plans in all states.

The policy in California was called Freedom Blue, and for $7 per month, you could get a full coverage PPO style health plan. This made it a very affordable plan for older people who do not have health plan coverage through their spouse or former workplace. Another option was that you could have your plan premiums automatically deducted from your Social Security payments, meaning one less bill to worry about.

One of the distinct downsides of these plans, that I have found, is that many medical facilities are not aware of these plans or how they work. On several occasions, in spite of my instructions to the contrary, facilities would bill directly to Medicare (which would say they are not handling the patient) and then turn around and bill us for the full amount with a note saying that Medicare denied charges. I would then have to call them back and explain the whole thing again, and even then, some places would continue getting it wrong. It was quite a headache at times. Hopefully this will get better in the future, but keep this in mind if your state or area has just begun accepting this kind of plan.

In the case of Blue Cross, they will explain that this particular plan is a low-cost solution that is best for people who are still in relatively good health that are seeing doctors only occasionally for checkups. In my Mother’s case, it might not have been optimal since she was dealing with Diabetes, and a number of other health problems. We had tried it in an attempt to circumvent other problems we were having dealing with Medicare and her primary physician.

You will have to explore these options for yourself at length, but I would say that it is best designed for people who need some medical and prescription help, but are still doing well, and are active, but don’t have any regular health coverage.

(*information about insurance companies and their policies are not endorsements, but are simply accounts of my experience. I recommend you check several different policies and companies before making a choice.)