Alzheimer's caregivers, guardians, and conservators

[circular]

Oh my, I sure am not the only one dealing with this craziness! My LO was just like your uncle when they visited her. Out to impress! I think I will go through the roof if they deny our claim again. This has been so stressful! She's hosing money on caregivers.

[circular]

My LO was the same way Julie. Out to impress and what a tangled web she wove! I got three letters from various of her specialists for the appeal, since the insurance company believed her over the letter from her internist submitted with the original claim

I just saw this thread about the study that is paying for PET scans for Medicare beneficiaries. My LO did this last winter. That has also been submitted on appeal because it indicates the scan is consistent with Alzheimer's. It might be helpful for anyone else going through this to ask the neurologist to help the patient participate in the PET scan trial for additional documentation.

[Nords]

Thanks Nords! That is very encouraging that we might get a favorable outcome on appeal. I posted elsewhere how my LO keeps passing the MMSE. Thankfully we got a second, followup neuropsych in time for the appeal paperwork and it says Alzheimer's. I told the neuropsych doc when he interviewed me that the MMSE is the bane of my existence, and he laughed as if to say, 'ya, what a piece of junk that is', although I don't mean to be quoted as saying an expert said those words. It was just my takeaway.

My LO was the same way Julie. Out to impress and what a tangled web she wove! I got three letters from various of her specialists for the appeal, since the insurance company believed her over the letter from her internist submitted with the original claim :evil:

I just saw this thread about the study that is paying for PET scans for Medicare beneficiaries. My LO did this last winter. That has also been submitted on appeal because it indicates the scan is consistent with Alzheimer's. It might be helpful for anyone else going through this to ask the neurologist to help the patient participate in the PET scan trial for additional documentation.

You'd hope that if the neuropsych exam is good enough for the doctors and courts, then it's good enough for the long-term care insurance company. I've been told (but never had to follow through) that the next step is the state insurance commissioner's office. It's also a good time to consult with a geriatric care manager, who'd know how to discuss it with the care facility and the local city/county/state regulators.

... but practically popped up and offered to do one armed pushups for the attractive young nurse to show her how healthy he was...

Heck, I do that now.

My father's insurance company used to do an assessment once a year-- either with their contractor or by asking the care facility to fill out a form. I'd hear about it days or weeks later, and thankfully there never seemed to be an issue. But I think the most important part of the exam is talking to the person for 20 minutes. Eventually they begin to repeat their coffee-shop-conversation loop or show that they're in the wrong century. Families and care assistants see that first.

But in (scant) defense of the insurance company, some types of dementia symptoms are short-term or reversible. Vitamin B deficiencies (genetic or dietary) are legendary for dementia symptoms, as are thyroid problems. Doctors & hospitals are notorious for misdiagnosing emergency-room psychosis or even urinary tract infections. "Pump head" is a side effect of heart-lung machine use during cardiac surgery, and it's frequently months of symptoms. Marie Marley was diagnosed with mild cognitive impairment that turned out to be a combination of medications and sleep apnea. (It took a couple years to figure that out.) David Hilfiker blogged about his dementia symptoms for well over a year-- heading for an Alzheimer's diagnosis-- before finally being diagnosed with a cognitive impairment that's not Alzheimer's. I could go on for paragraphs about military veterans being treated for PTSD with SSRIs.

By the way, I've been reading Bob DeMarco's articles as they're emailed to me ever since you mentioned that site. They great easy bites to fit into busy days.

Glad it's helping; I'm learning a lot. Better still, my spouse reads it too, which gives us a common vocabulary for discussing our parents' symptoms with our siblings. Someday my brother and I are going to get asked about hospice for our father, and the website has already given us the help to guide that discussion.

[circular]

Thanks for mentioning the commissioner Nords. I hadn't thought of that. Hopefully it won't come to it. I'm on pins and needles waiting for the appeal decision, while ripping out my hair trying to track all the medical payments through various doctors, Medicare, Medicare supplement, my mother paying up front sometimes and not others, what gets reimbursed and what doesn't, and which actually got reimbursed that should have been, and when if ever can a doctor require up front payment and ... I hate this. Maybe just pay the bills I'm told are due and don't question, but mom used to get a lot of reimbursement checks from Medicare and Med Supp and this year has hardly gotten any at all. Ugh. Sorry for another vent.

[Nords]

Thanks for mentioning the commissioner Nords. I hadn't thought of that. Hopefully it won't come to it.

Sometimes just mentioning this option is all it takes. ("We thought your company would agree that the criteria have been met and would approve the claim. What are we supposed to do now? Contact our state insurance commissioner?") We all hope the insurers realize that it's cheaper to approve your elder's claim now rather than to spend thousands of dollars (and dozens of hours) of their employee payroll on delaying and denying... before approving your elder's claim anyway.

... while ripping out my hair trying to track all the medical payments through various doctors, Medicare, Medicare supplement, my mother paying up front sometimes and not others, what gets reimbursed and what doesn't, and which actually got reimbursed that should have been, and when if ever can a doctor require up front payment and ... I hate this. Maybe just pay the bills I'm told are due and don't question, but mom used to get a lot of reimbursement checks from Medicare and Med Supp and this year has hardly gotten any at all. Ugh. Sorry for another vent.

Yeah, I hear that. My favorites are the medical billing companies who invoice you once and then 30 days later send the next invoice straight to collections... while the first invoice doesn't get forwarded to you until Day #31 because it's been addressed to the insured at the skilled nursing facility and left among a pile of papers or in a drawer. Sometimes the collection agencies have called before I've even known there was an invoice.

My second favorite was the medical transport company who billed us the same $22.98 for nearly a year before they finally agreed to bill my father's Medicare supplemental insurance company... and then they couldn't format their invoice correctly. The supplemental insurer eventually forwarded their payment check to me, which I had to deposit (in Dad's name) to forward the $22.98 to the transport company. By which point I'd spent several times that value in life energy just to direct the paperwork.

My new favorite is the pharmacy who happily fills Dad's prescriptions every month and bills his pension's prescription insurance plan, yet for five of the last six months has "forgotten" to forward an invoice to me for Dad's copay. Somehow their system can't send me a monthly invoice yet can still add up the "past due" amounts. (Together with the 1.5%/month interest charges which have to be deleted by a human before I can pay them the correct amount.) I'm about to restart that conversation again next week.

When a doctor's office asks "How are you paying today?" we ask them to bill my Dad directly. (Using my mailing address or e-mail address.) If the office wants payment up front then I charge my credit card (I closed Dad's credit cards years ago) and reimburse myself. (The probate court has never questioned this in my annual reports. They understand.) Most of the time the medical office bills Medicare and then invoices Dad for the copay, which eventually gets to my mailbox or my IN box. Then I redirect the biller to Dad's Medicare supplemental insurance company, which seems to be hard for me to do by phone yet is downright impossible for me to do by e-mail or postal mail.

The good news is that if it's a routine Medicare procedure (a weekly exam, or a quarterly blood test, or some other regular visitor to the care facility) then once I've connected the biller to the Medicare supplemental insurer I never have to do it again. I've been able to track my copies of the paperwork to check that all the payments were made, and then I just file them in case I get a query.

I usually ignore any past-due fees or interest charges. ("Those charges are not appropriate because they're caused by your improper billing and administrative delays.") The billers seem to recognize that it's too hard to collect on them.

[circular]

Thanks for being my misery loves company company Bro! Crazy how endless the little things are. What I don't understand about your situation is that Medicare should automatically be passing along statements of what it's not paying to the Medicare supplement company. Is your father's insurance from a former employer? I think that can change the mechanisms. Gee you may have it worse in this department worse than me. Things normally go smoothly with my mother's medical paperwork, it was just the case of the disappearing reimbursement checks. After my post I actually got help from Medicare's live chat online (shock!). "She" was able to go into mom's account while I waited and see that three doctors are taking payments from both my mother and Medicare and not reimbursing my mother! So tomorrow I get to call them all (three!) and say, "fork it over or the same attorney who might have to sue the long-term care insurance might also be suing you." And oh ya, I just today wrote a check to my mother to reimburse her for a refund that was made out to me instead of her... Seems like such small things but they all add up to wondering what happened to my own life while I put out the next fire.

[Nords]

Thanks for being my misery loves company company Bro! Crazy how endless the little things are. What I don't understand about your situation is that Medicare should automatically be passing along statements of what it's not paying to the Medicare supplement company. Is your father's insurance from a former employer? I think that can change the mechanisms. Gee you may have it worse in this department worse than me. Things normally go smoothly with my mother's medical paperwork, it was just the case of the disappearing reimbursement checks.

You're welcome!

I did not know that Medicare would pass along an explanation of benefits to the supplemental insurance company. I'll have to check to see whether that's actually happening (without my understanding that) or if I need to do something. For Dad's routine medical care, the billing to the supplemental insurance company seems to be automatically done by the company providing the care. It's the new services (or the one-time events) that I usually have to step in and redirect the Medicare copayment billing to his insurer.

[circular]

Is his plan a traditional 'Medicare supplement' plan with a letter designation based on what it covers of approved Medicare expenses? Or does he have a retiree plan through an employer with its own features?

[Nords]

Is his plan a traditional 'Medicare supplement' plan with a letter designation based on what it covers of approved Medicare expenses? Or does he have a retiree plan through an employer with its own features?

Sorry, I misunderstood the question.

I don't think it's a letter designation but rather a supplemental plan bought on the open market from the insurance company Bankers Life & Casualty. Or would that policy be considered an optional component of the "B" portion of Medicare? It's just intended to cover the 20% cost share that beneficiaries have to pay for Medicare expenses. It costs about $4600/year, but if he has one medical incident during the year then he "wins" on the expense.

I've never looked into its designations or alternatives. Dad bought it when he started Medicare in 1999 and I haven't had a reason to mess with it.

His prescription insurance is through his pension plan (Viacom/CBS, the company which owned his portion of Westinghouse). That insurance program is now being managed by CVS, and they're not exactly the easiest bureaucracy to work with. Dad's no longer on Namenda or Aricept but he's still on a mix of Lisinopril (blood pressure) plus small doses of anti-anxiety and anti-depressant meds. But the good news is that he has insurance and it's saved him thousands of dollars over the years.

[circular]

It sounds like you have one of the versions of a Medicare supplement policy. What they cover is standardized across the companies that sell them, and there are different MS policies going by letter designation that supplement different Medicare benefits. While the coverage will be identical across companies, making premium comparisons worthwhile, I'd forgotten that some companies work seamlessly with Medicare while others don't. I believe the term used for that administrative benefit is Automatic Claims Processing (or similar). The AARP Medicare Supplement plans with United Healthcare have it. The providers bill Medicare, Medicare makes their determination and then if a balance is still due sends their statement directly to the Medicare Supplement company for handling the balance. My mom has the most comprehensive Medicare supplement policy, so I'm not sure, if the Medicare Supplement policy is one that doesn't cover everything, how or when the patient's portion gets paid (up front to be reimbursed or at the back end when the exact patient contribution is known). The automatic claims processing and customer service with AARP UnitedHealthcare is very good. I just seem to have a hitch at the provider level getting reimbursement. The doctors are wonderful and I'm sure they have no clue they're getting paid twice for my mother.

What's Medicare Supplement Insurance (Medigap)?

I recently found out that my father's retirement plan that "supplements" Medicare is another beast entirely. Rather than filling in gaps in Medicare, for Medicare approved expenses, it's an indemnity plan that pays for healthcare and providers that Medicare wouldn't cover at all. It has it's own processes.

While future caregivers may not be reading this thread, it wouldn't hurt for children to be educated and involved with their parents Medicare coverage decisions. They'll be dealing with their parents choices down the road. Certainly a lot of parents going on Medicare are fully capable of making their own decisions about it, but it might help if they write out or have a conversation with their children as to why they made their choices. The reasons may or may not continue to hold up well as circumstances change.

It sounds like at least you're getting the coverage you need, even if there are some logistical hiccups which are bound to occur under any setup.