RIP Dad, You're the Best!

My father passed away on July 28th. He was 84 years old and had been in declining health for quite awhile. He had lung cancer, (was a long-time smoker, but had quit 20+ years ago), went through radiation, (which gave him an additional 6+ months), but succumbed to a heart attack, as his cancer was putting pressure on his already weakened heart. He spent his final days at his summer home in Brookings, Oregon, and unexpectedly passed 3 days after he came back to his permanent home in Northern California.

My parents were proactive a few years back and planned for their deaths.  My father was a Korean War Veteran and requested a memorial service at the local funeral home first, followed by internment at a nearby Veterans Cemetery. His wishes included the 21 gun salute, bugle, and the flag folding ceremony with all the bells and whistles. 

My mother has since found out that all your best pre-planned arrangements may not go as smoothly as hoped. To start off with, both my parents signed up for a pre-paid cremation service. That was fine, but since my father passed at home, (after family members paid their final goodbyes and hospice was notified and had come and gone), we called the cremation organization to pick up his body.  Little did my parents realize, that the organization they signed up with was two hours south of them. They first had to get a team in place, then drive up and pick up his body. Next, another surprise was the length of time that it actually takes to get the cremation done. They first need a signed death certificate from the physician, which can take up to 5-7 days, then they seemed to need additional paperwork faxed over from my mother. They indicated the whole process could take up to 15 days! Lastly, the cremains were to be shipped back to my mother with the proper permits and such for burial.

My mother was hoping to have the local memorial service and internment all at the same time, but due to the uncertainty of the cremation timeline, she did the memorial first. Next, we had to plan a time for the internment. As the Veterans Cemetery has only certain days that they do services and also have to rely on retired Veterans to do the gun salute, we were at another standstill. We finally were able to get all the pieces in place, and the actual internment took place a month after his death. It was a lovely service and actually FREE to military members. My mother will also be interned next to my father, but as she was not a Veteran, there will be a cost of ~ $750.00 for her. 

This brings me to what a nice benefit the Veterans have for their loved ones passing. The Cemetery we went to was nicely kept and very professional. They did a nice service and all expectations were met. You can actually have the full service at the Chapel at the Veterans Cemetery, but as I previously mentioned, my father wanted a separate one at the local funeral home first. 

If you have a love one that served in the military and hasn't made their wishes known, it might be time to have the "talk" with them. It's a great benefit for their service to their country and one that families may not be aware of.

Ca Veterans Cemeteries

Kevin MD - A Great Site to Visit

I'm going to keep my blog post short and sweet today. I have found a blog called KevinMD.com that is a wealth of information from a physicians point-of-view. It talks from everything from abuse by patients using the Emergency Department as their personal physician, to people going broke because they can't afford care.

Please take the time to check this very informative blog out. It's great to see that there is a MD that is rooting for patients and patient care. Oh, and have a happy and safe 4^th of July!

http://www.kevinmd.com/blog/

http://www.kevinmd.com/blog/

Have Healthcare Changes Impacted Your Life?

Healthcare has changed significantly over the last several decades. It used to be that you had a Primary Care Physician (PCP), which may have been referred to as your "Family Doctor", that took care of all of yours and your families health care needs. He (and in rare circumstances she), would see you for the common cold, deliver your baby, and possibly make a house call if you were too sick to come to their office. And, if you had to be admitted to the hospital, your PCP would most likely be the one who cared for you the entire time.  

Nowadays, it's a new ball game. You may have a PCP, but if you need specialized care, you will most likely have a different physician for that. For example, my daughter had a perinatologist for her entire pregnancy care. (I had my Family Doctor.) When it came time for her to deliver her baby, her perinatologist wasn't on call. It was actually a midwife that delivered her baby. Her perninatologist never even saw her during the time she was in the hospital. She did see her for her six-week postpartum check up, and that will be her last visit with her. Also, if you get admitted to the hospital, you might have a hospitalist to take care of all, (or most), or your medical needs and never see your PCP. You also will probably have a barrage of doctors to take care of your different healthcare needs.

I'm also sure that you're used to having to pay a co-pay or your portion due now at the time that you're seen. It used to be that you could pay when you received your doctors bill in the mail, and if need be, make payments on it.

Also, remember when your doctor could just order a test if you needed it? Now it usually has to go through a whole pre-authorization process with your insurance company, and even at that, it could get denied.

What do you think? Do you like all the health care changes or would you rather see it go back to the "Good 'ol Days"? I for one, prefer the way it used to be. I had my family doctor from the time I was two years old, until the time he retired. He took care of four generations of my family and was not only my doctor, but a friend as well.

     

What to Expect if a Relative Goes Into a Nursing Home

My eighty-eight year old father-in-law recently fell at home, (he was by himself), and broke his hip.  

Unfortunately, his Life Alert alarm was in his nightstand drawer, and his fall took place in his living room. It took him two hours to make it to a phone. He called his daughter and son (who lived about twenty minutes away), to come over and help him BUT, unfortunately once they got there, neither of them had a key to his house. When they both arrived, they both came prepared with screwdrivers in hand, hoping to find a window that they could budge.

To make a long story short, they were able to crawl in through an unlocked window and call an ambulance. At the hospital, it was determined that his right hip was broken. He ended up having surgery that night, where he had a rod and three screws placed. After surgery, he was transferred to the ICU, (Intensive Care Unit), then shortly moved to a regular room. He ended up staying four days in the hospital, then he was transferred to a SNF, (Skilled Nursing Facility), for rehabilitation. At this point, his insurance covered his first twenty days in rehab.

Situation	Is my SNF stay covered?
You came to the Emergency Department (ED) and were formally admitted to the hospital with a doctor’s order as an inpatient for 3 days. You were discharged on the 4th day.	Yes. You met the 3-day inpatient hospital stay requirement for a covered SNF stay.
You came to the ED and spent one day getting observation services. Then, you were formally admitted to the hospital as an inpatient for 2 more days.	No. Even though you spent 3 days in the hospital, you were considered an outpatient while getting ED and observation services. These days don’t count toward the 3-day inpatient hospital stay requirement.

Now, this is where it gets tricky.  His orthopedic surgeon told him that due to the severity of his break, he would have to remain completely non-weight bearing on his broken hip, for up to four months. According to Medicare guidelines, they will only pay the first twenty days of rehab. After that, if you don't have a supplemental that picks up the balances, (he has Vetrans insurance), you are reponsible for $161.00/day for days 21-100.  This is exactly where he fell; paying $161.00/day.

Your costs in Original Medicare

You pay:

• Days 1–20: $0 for each benefit period.

• Days 21–100: $161 coinsurance per day of each benefit period.

• Days 101 and beyond: all costs.

Medicare Guidelines

Thankfully, he was able to go home after about two weeks of paying $161.00/day. His daughter was able to make arrangements for caregivers to be with him basically 24 hours/day. It's actually costing more than the SNF for now, but he is at home and mentally doing much better. 

If you are of Medicare age, or have parents or relatives that have Medicare, PLEASE take the time to review your supplemental insuance policies. It was quite shocking to find out how much money a serious injury can cost you, and not all people are prepared for this expense. You may even need to talk to your insurance agent to see if there are any supplemental policies that cover instances like this.

Is Your Provider Billing You Correctly?

One of my relatives have recently had three disputes regarding her insurance bills/claims with her medical providers. One was at a specialists office and the other two with her primary care provider.

First off, she had a MRI at a radiology clinic. She was told up front what her portion of the fee would be. She paid that at her time of visit. Now, we know that most times this is only an "estimate". The amount owed can go up or down a little. When I worked in a radiology office, we always called the patients insuance company to find out what their deductible was, their out-of-pocket and how much had been met so far. This would give us a guildeline for what the patient owed. We usually nailed it exactly, but if there were outstanding claims that the insurance company got before ours, sometimes the patients portions were met, but just didn't show up on paper yet.

Anyway, my relative went to a preferred provider, so that she got the best possible benefit from her insuance.  She was quite surprised when she received a bill for a substanial amount of money. After reviewing her EOB (Explanation Of Benefits) with what was paid, adjusted and what she paid, she figured that she owed nothing. She called the radiology office and gave them her payment information with them, and went over her EOB. In the end, it sounds like they didn't take the correct adjustment and billed her for this, after she made her original payment. Had she not known to look into this and just paid it, she would most likely have been out hundreds of dollars.

The same thing happened with her doctors office. Same scenario. She paid her portion due at the time of service and was billed again for a substantial amount of money. Not only did they do this once, but twice!

How many unsuspecting people do you think overpay their bills and think nothing of it? I know from experience, that unless you advocate for yourself and keep track of your claims, no one else will do it for you.

Have you had any similiar experiences? Have you ever had to question any bills? Do you have any outstanding bills that you feel you don't owe on? If so, maybe I can help. Just email me your questions, (you don't need to give me any personal information, numbers or anything like that). I can tell you what to look for, and how to go about getting it corrected. 



I hope this never happens to any of you, but if you think you have been billed in error, don't be embarrased to call and ask questions. After all, you probably pay a lot of money for your insurance in the first place, and having to pay extra, just doesn't make sense!

YOU are the best Advocate for your Medical Care

I have come to theconclusion that You are the best advocate for your Medical Care. This comes after all the trials and tribulations that my own mother has gone through after recently being diagnosed with breast cancer. Let me give you the scenario - 

My mother had a mammogram, which came back stating that she needed additional testing. Her physician called her and ordered an ultrasound to further diagnose any suspicious areas. Seems pretty by-the-book so far, doesn't it? Well, now is not the time to get too confident on physician follow up or referals. As a side note, she has Medicare as her primary insurance and Blue Cross secondary. Not a HMO or Medi-Caid type of insurance that would need to go through a lengthy referral/authorization process to order tests. 

My mother had the ultrasound, then nothing.  No call from her doctor or the radiology clinic where she had the ultrasound. Makes you say hummmm, what's going on? 

After close to after two weeks have lapsed, my sister and I convinced her that to call her doctor's office to find out what's going on. She finally called and was told that she had a suspicious area and needed a breast biopsy. 

Now chapter two of the waiting game begins. Her doctor was going to send in a referral to a place to have this done. Another week passes and my mother hasn't heard anything. She calls to the office where she had her ultrasound and they don't have any orders. She calls back to the doctors office and the doctor "blames" this on the the new computer system that she's using. Personally, I don't see how that factored into anything, but the doctor says she'll send the order to a town thirty miles north of where she lives for the biopsy.

Chapter three: A couple weeks have passed again and there is no word from the biopsy office. My mother is eighty-three years old, and is under the impression that the radiologist needs to review her previous films first, and just figured that everything must by "okay", since no one called her. My mother finally called them and, my sister called them and they both get the run-around.  I finally get frustrated, (I live 600 miles south of my mother), and call her primary care doctors office. I tell them that someone has dropped-the-ball and nothing has happened. This message miracuously gets to her doctor and gets the ball rolling. Next thing we know, the place where she is supposed to have the biopsy have the order and have her scheduled.

To make a long story short, the biopsy comes back positive for breast cancer and she gets referred to a breast specialist who does a lumpectomy. After the lumpectomy she has eight weeks of radition, and now is on an oral cancer medication. And most importantly, she seems to be doing pretty well.

I'll reiterate the moral of this story. Like I said in the beginning of this blog;

You are the best advocate 

for your Medical Care!

I hope that you or your loved ones never have to go through something like this, but if you do, assume nothing. If you don't hear back from your physicians office, make the call. Don't assume that they will call you. You need to speak up and be proactive.

Emergency Rooms.....Emergency or Not?

I've recently been volunteering at our local emergency room. I sit behind the window and help visitors when they come to visit patients in the Emergency Room. Whoa, why is this? You mean people actually need visitors when they're at the ER to get immediate help? Yes they do, and I'll explain why.

Where I volunteer, there can be up to more than 100 patients in the ER at a time. This includes the waiting room, patients that are in rooms, and patients that are having other services (x-rays, labs, etc), while waiting to be seen. I have seen patients that have been in the ER in excess of 6 hours from the moment they came through the front door, to when they left.

It seems to me that the Emergency Room is one of the most abused services that I've ever seen.  When I think of an emergency, I think of something that needs urgent attention and doesn't happen during regular doctors office hours. Well, apparently this is where my thinking is misguided. People come to the emergency room when they have had a sprained ankle for two weeks to needing pain pills refilled! Ughh. Of course, there are the patients that do need emergent care, but the number of abusers far outweigh the ones that truely need it. Patients also think that if they come in via an ambulance that they will get moved to the front of the line and treated first. This is not so either. Once the patient has been triaged, and off-loaded off the stretcher, they can end up in the waiting room just like everyone else.

Also, a lot of people think that the ER is a full-service hotel. I've had family members of patients ask me to get them a sandwich because they're hungry. They are not even the patient! There is a fully-stocked cafteteria down the hallway, but people feel entitled to a free meal while they're waiting. Of course we feed the patients if necessary, but can't cater to the whole family and their friends. 

Another reason why they may choose the ER over urgent care over their doctor.....money!  The ER can ask to collect co-pays and money due up front, BUT they can not force anyone to pay. The ER can NOT turn anyone away for non-payment up front, where as your doctor's office may turn you away if you don't have the correct funds to give them as the time-of-service.  

Thank goodness there is a system in place that protects the patients that are truely in need of emergent care vs the ones that do not.  This is called TRIAGE.  

tri·age

  (trē-äzh′, trē′äzh′)

n.

1. A process for sorting injured people into groups based on their need for or likely benefit from immediate medical treatment. Triage isused in hospital emergency rooms, on battlefields, and at disaster sites when limited medical resources must be allocated.

2. A process in which things are ranked in terms of importance or priority: 

tr.v. tri·aged, tri·ag·ing, tri·ag·es

To sort or allocate by triage: triaged the patients according to their symptoms.

Triage nurses carefully determine the severity of the illness and are able to "rank" the patient in order of urgency, not first come, first served.

I personally would not want to go to the ER if it were not a true emergency. You have no idea what you are being exposed to in the waiting room. Though there are masks available for people that are coughing, or people to protect themselves, not everyone that should have one uses one. 

Lastly a great article to read is this... To the Woman who doesn't understand why I was seen before her at the ER.  /http://themighty.com/2015/11/to-the-woman-who-doesnt-understand-why-i-was-seen-before-her-at-the-er/

It helps explain from a patient's point-of-view what goes on in the Emergency Room.