Medicare Rules

I’ve been going from hospital to rehab to rehab without anyone giving me a bill (yet), though insurance was questioned. I’m grateful to have original Medicare A+B with a medicap supplement, which covers a lot. But they have strict rules and I learned about some of them today.

Although I was told when I left Rehab #1 that Medicare + Insurance would cover up to 100 days at Rehab #2, they didn’t talk about what “up to 100 days” actually meant. Logically enough, it depends on my progress. They won’t pay for more days than they have to, so therapy needs to let me (and them) know when that cut off time could be. Apparently when I got here, the estimated target date for discharge was November 1st. It could be much earlier than that, but hopefully not until I will be safe when I leave.

I have visions of being packed up and sent down the hill to my barely remembered apartment, only to find I can’t get in and out of the bed, or fall down trying to get dressed. I know this isn’t realistic, that they will not kick me out of here until it’s safe for me to be independent, but it just seems as though it’s going to take me longer to get there than Medicare will let me stay, now that I know about this rule. I need to work harder to learn the things I have to learn so I feel confident.

I wish someone had talked to me about this before, say, when I got here. Or that I’d done more research on it myself. I’m not a stupid person and there are always ways to get information if you try. I just have been merrily going along trying to stand up, walk, and get stronger that I never really thought about what came next as happening as soon as it probably will.

Feeling unsettled and wary. No wonder my blood pressure was so high when they just took it.

Medicare and what?

I signed up for Medicare when I turned 65, looking forward to spending hundreds of dollars less for good medical care. But figuring out the options wasn’t that simple because everyone and his brother wants to sell you gap insurance to make up the difference between what Medicare pays and what the costs actually are. If you’re not careful when you’re researching, you end up giving permission for everyone to call and text you to hard sell you on their insurance.

I’m a librarian and I love to research – and I also read the fine print so I didn’t sign up with any of those people. Instead, I contacted an insurance agent who specializes in medical insurance. We discussed how it worked and she sent me information about 52 different policies that all covered Plan G (my chosen option) in Texas. At her suggestion, I talked with my doctors to find out if they had companies that they did or didn’t find easy to work with. They all strongly did not like United Health Care or Medicare Advantage plans, so I steered clear of them. I signed up for Original Medicare + Plan G gap coverage from Mutual of Omaha + Part D (prescription) coverage from Wellcare. I’ve had no regrets.

The case manager at my first rehab facility told me that my choice of coverage made things easy for him – and for me – to get additional care, and that I had the “Gold Standard” of coverage. He hates Medicare Advantage plans because, although they are cheaper and cover things like dental and eye care, they make it harder for a patient to get more therapy because insurance wouldn’t cover it or would make it harder for the providers to get paid. My coverage (Original Medicare + Mutual of Omaha) fully covers 100 days of additional therapy. He really hates Joe Namath and the others who do commercials for Medicare Advantage plans because they persuade people to sign up without really researching long-term complicated coverage questions.

So if you’re approaching Medicare insurance time, do your homework. Don’t just look at the monthly fee. Look at the coverage, talk to doctors’ offices (I talked to the finance office), and go to an insurance agent who represents many companies and not just one. If an Advantage plan is financially best for you, fine. But ask lots of questions about complicated health condition situations – like the need for long-term therapy.

Health is Relative

Medical logoBetween my balky knee and a pain across the top of my foot, I’ve been lurching around and walking a bit oddly today. Okay, very oddly. The knee is hot to the touch in one spot and isn’t bending very well. The foot has been shooting hot pain when I bend it to take a step. I thought that was because I had the shoe tied too tight, but now it’s doing it at home when I’m in my slippers. My arthritic toe on the other foot is swollen and unhappy.

But all it took was a phone call with my parents tonight to put my stuff in perspective.

My aunt is in the hospital with kidney problems, sky high blood pressure, and some mysterious other things that aren’t clear to us or the doctor. Her daughter, my youngest cousin, is facing cardiac catheterization to address continuing medical problems related to throat cancer – and they have no medical insurance. Their company dropped them like a hot potato when they missed a payment, probably glad of a reason to not continue carrying someone who is incurring such high expenses.

I have so much. I have insurance with generous coverage and minimal copays. I have access to excellent doctors and hospitals. I am generally in good health with prescriptions to help with the ongoing medical conditions such as sleep apnea and arthritis. I have the money to pay for what I need, with a comfortable home and a good job.

I’m not close to my aunt and cousin but they are family and will be in my prayers, as I also give thanks for my many blessings.

Day in Insurance Hell

Evil Insurance GuyThe sinking feeling started when I saw the envelope from the insurance company. It was highly unlikely that they would be writing to wish me a nice day or send money, and they didn’t. Instead, it was a Claim Summary that basically said I was going to end up owing someone $450. Since I moved and changed employers, I am no longer a patient and they were denying the claim from the company that provided my CPAP machine.

Oops. I really did blow this because I totally forgot that the thing wasn’t mine; it belongs to the durable medical equipment (DME) company. I should have notified someone of the move and found out what to do with the machine but I just forgot. Never having seen any paperwork for it from the DME or the insurance company, little things like payment had never been a factor once I was approved to get it.

Of course, it was after 6pm and everyone everywhere was gone for the day, leaving me to be fret and worry about how to handle it and trying to figure out what the $450 was actually FOR – surely not for one month! Eeeek, that’s ridiculous, I can buy a whole new machine off the web for $900, and I’ve had this one since March. I got myself all worked up into fear that I would have to send back the CPAP that I have immediately so I didn’t get billed for more time, and would just take my chances with breathing until I can get sorted out with the new medical plan.

Today I spoke with medical insurance companies in two states, as well as two DME companies, and our medical center office. I have no more idea what’s happening than I did last night. Basically here’s the deal: the CT insurance won’t provide a new CPAP until I’ve had a new sleep study, which usually ResMed CPAP machine (minus the face mask and tubing)takes at least a month to schedule and another month for the results to be available. I owe my MA DME company for at least two months for my current machine, but magically at $95 instead of $450/month. The CT company may or may not reimburse me if I pay out of pocket.

Of course, if I just keep paying the MA company until December, I will own the current machine. It would be lots cheaper than starting over again here, and even the person I talked to seemed to see the value of saving money. She was also very anxious that I not give up my old machine until we figure out how to get me covered going forward. Which means I pay for it since they’re not sure they can pay for something provided from an out of state provider and prescribed by a doctor outside the plan.

The new medical office people were displeased that my file was so skimpy even when I explained that I was a new patient who hadn’t even been seen by a doctor there because they had to reschedule the one I booked three weeks in advance. It’s a good thing this is NOT an emergency, though perhaps they would be more responsive then.

This is not life-threatening, just annoying and expensive, and I’m a smart person who can figure it out. But even what I did today had me practically in tears. Even so, I didn’t get all snacky and eat my way through the stress and that’s a good step.