Banner photo of Larry Eugene Meredith, Patrick Flynn and Ronald Tipton, 2016.

The good times are memories
In the drinking of elder men...

-- Larry E.
Time II

Thursday, July 5, 2012

HMO - HO HO HO!

There is an old saying, "You get what you pay for."  This is said when someone complains about something they paid little or nothing for; something bought on the cheap, a bargain, a perceived good deal, and then it doesn't work well.

"I bought this two dollar watch off a guy in the street and it stopped keeping time two days later."

"Well, you get what you pay for," is what the fool is told.

Quite often this saying is true.  Not in the case of the Medicare Advantage Plans, at least not the one offered by the A-As-In-Hole Insurance Company. "One of the wonderful things about reaching age 65," a TV ad tells us, "is Medicare." (Not an A-As-In-Hole ad in case you are guessing.) Medicare may or may not be wonderful, but most certainly the Advantage plans aren't. But who knew? Most people I have spoken with about what happened to my mother are amazed when the medicare Advantage is explained to them. I have to admit I didn't know what they were.

I thought they were Medicare Supplement Insurance, you know, policies that cover what Medicare doesn't, like co-pays and deductibles.

By the way, this is another thing where "you get what you pay for" doesn't apply, Medicare Supplement Plans (known as Medigap). You'll see ads from Company Y pushing their supplement plan as being better than Company X, and you are only paying a little more a month. Well, then pick Company X because these supplemental plans are standardized by the government. There is a menu of 10 choices. Each choice offers some additional services, for example Choice C offer Skilled Nursing Co-Pay Coverage, while Choice B doesn't and Choice K only offers 50%; however, Choices B and K don't cover the Part B Annual Deductible while Choice C does.

You need to select the Medigap coverage you think you'll need. Perhaps you never leave the country, so you don't need Choice C because it covers out-of-country emergency care. But whatever Choice you make remember it is exactly the same coverage you will get through Insurance Company X as Company Y, so don't take the one charging a higher premium.

I noticed when we visited one nursing home and I told the Admissions Director my mom had a Medicare Supplement plan called A-As-In-Hole Medicare Super-Duper that she wrinkled her nose.

"That's not a supplement plan," was all she said.

Now remember there were all those crossed off nursing homes that wouldn't accept my mother's insurance. It did seem funny that something from one of the best known insurance companies in the country called Super-Duper Plan would not be universally accepted.

When my mother's coverage was dropped after 43 days instead of the 100 days Medicare normally covers for such therapy I found out why these places wanted nothing to do with it.

I was put in contact with an insurance specialist both by a nursing home and a friend. He explained the different animals. He said my mom would have been fine if she had traditional Medicare, in other words Plan A and B, even without supplemental. What she has is definitely not supplemental.

I had a friend ask me if my mother had the Medicare Plan B premium deducted on her Social Security. Indeed, she did. He said she had Plan B coverage then. Not exactly, what she has is a Medicare Advantage Plan that gives the same coverage as Plan B and she gets the privilege of paying the Plan B premium to the government as well as an additional $145 a month to A-As-In-Hole Insurance Company for it.

So just what is this animal? It is really Super-Duper? Not so much. The A-As-In-Hole Medicare Super-Duper Plan gives you, by law, everything Plan A and B of Medicare does. It still has all the deductibles and Co-Pays, may even have a few additional ones. It doesn't supplement anything. It does include Part D, the prescription drug portion. But you can get Plan D coverage for under $40 a month, so what is the other $105 a month she is paying get her? Remember, she is also paying Medicare her $96.50 a month, but Medicare itself is not providing any of her coverage. No-no-no, A-As-In-Hole is doing it all. No claims ever go to Medicare at all.

It works this way. Medicare collects the regular premium from Mom's Social Security every month. Medicare then pays A-As-In-Hole a portion of that amount. Thus the government makes a little money on the deal. A-As-In-Hole takes that fee and adds their own premium, the $145 a month and agrees to cover what Parts A & B do.

So why would anyone go for this, you ask? Because when you are our age and you see the ad telling you how great the Super-Duper Plan is because it not only covers your Medicare care, but your drug prescriptions and your eye exams and glasses and your hearing aids and hearing exams and for an additional $10 a month your dental, it sounds like a good deal to a lot of us Seasoned Citizens. But since you can get a separate policy for Plan D at less than $40, that $105 additional a month should easily cover those other costs for most of us with money left over in our bank accounts.

And The A-As-In-Hole Insurance company and its cohorts who offer these Medicare Advantage Plans are allowed to make their own rules in some areas.

Thus instead of the 100 days of rehabilitation my mom would have received under traditional Medicare, she was cut off at 43 days by her supposedly Super-Duper Insurance Coverage.

Now a further note concerning my dad, who has this same type policy. It is even more odorous since he already gets his prescriptions and hearing aid needs through the VA as a combat veteran of WWII. What in the world is he getting for that $145 a month?








Monday, July 2, 2012

Stay Away or Be Betrayed By A-As-In-Hole Insurance Company

When my mother had her April Fool's Day stroke her left side was affected. Her left leg and left arm would not work and she could not swallow food. On the twelfth day of April This City Hospital inserted a plug tube in through the stomach wall to allow feeding via of a nutritious if ugly brown liquid from a bottle.

On the thirteenth day of April the Hospital shipped her off to Sunset City supposedly for rehabilitation.

And rub-a-dub-dub she did get rehabilitation from three therapists at this hub, The Physical, The Occupational and the Speech.  Speech is a bit of a misnomer for my mother's talking wasn't at all affected by her stroke. She could speak as well as ever. But Speech Therapy apparently covers all things mouth and throat and this therapist was there to help her regain the ability to eat real food again.

These therapies were doing some good. My mother was regaining movement in her left leg, to the extent at least that she could move it back and forth and reposition it in bed. The left hand was the stubborn part. From the beginning she could raise that arm, but her hand stayed immovable with the fingers squished together. The best that had happened after 39 days of therapy was a slight wiggling of her fingertips.

However, her swallowing was quite another story and in some way the swallowing was the most important of the therapies. If my mother could regain her ability to eat real food it would increase her quality of life immensely even if she did remain handicapped in her extremities. If she could not walk again she would at best be able to enjoy the taste of her favorite foods. This would also allow her to be more mobile, albeit with the use of a wheelchair. It was difficult for her to be moved with the feeding tube. Without it she could be taken to have meals in the cafeteria with other residents, enjoy a meal and perhaps some conversation.

By the 39th day she was eating selected foods such as yogurt and pudding. However, on the 39th day there was a great leap forward. On that day Sunset City took her to a Distant Hospital for a video digital scan of her mouth and throat. Distant Hospital had a far greater reputation in this field than This City Hospital, although my mother complained about them taking her so far rather than across the street.

The next morning I had an email from one of her friends that they had visited that night and she was eating a peanut butter and jelly sandwich. Whoa, I thought. If she can swallow a PB&J then can't she swallow everything? I have difficulty sometimes swallowing peanut butter.

When I visited the next day it was lunch time and mom was sitting up in bed being fed normal food, the menu item of the day for the noon meal, macaroni & cheese and a fruit salad. (She said she passed on the chicken as it was a bit chewy.)  She was also eating this straight up, just as you and I would eat. Prior to this to sup on a cup of yogurt she had been forced to turn her head to the left and down with her chin practically on her shoulder. This was to help force the left muscles of the esophagus to push the food along.

What they saw on that video scan changed things. My mother has a pouch in her throat. It is a pre-existing condition. Her personal doctor has recommended surgery a couple years or so back, but she refused because she didn't want to leave dad home alone while she was in hospital. Somewhat ironic as things turned out.

It is my opinion this pouch was more the culprit with her swallowing situation than her stroke. Nonetheless, on the 40th day of her rehabilitation she had made great progress within the last 10 days. Her left leg had become mobile again. She still couldn't "stand and pivot," meaning she couldn't walk, but the Occupational Therapist told me the problem was her right leg was too week to support the left. It was certainly possible with continuing therapy this might be strengthen enough to allow her to stand. If it couldn't she would be limited to a wheelchair, but people can propel a wheel chair with their feet and at this point that seemed a possibility. And she was now able to eat normal meals portending a time when she might actually be rid of the feeding tube.

Everything was looking good.

Then on the 42nd day A-As-In-Hole Insurance Company cut the strings.

On the Friday afternoon of Memorial Day Weekend they sent notice that they would no longer provide coverage for her therapy because she had plateaued, as they called it, and no progress was being made.

The insurance coverage ended on May 28 and so did her therapy and so did her eating of any real food.

TO BE CONTINUED