Make Health Insurance Choices Understandable

My Mom (84 years old) came to stay with us for an extended vacation back in August. When she arrived she was having difficulty getting around because of bad knees. She had a total knee replacement on the right side and never properly recovered. Part of the reason is that she lived in a row home in Philadelphia. She had to climb 10 steps just to get up to the house, thirteen to go use the bathroom or go to bed and another thirteen to go and wash clothes or get something out of the freezer. Sometimes she had to crawl up and down the steps.

When she arrived here, we made an appointment to see our family doctor. When we called for the appointment we asked if they accepted her health insurance and were told “yes”. When we arrived for the appointment she was told that, with her insurance and Medicare, she didn’t even have to pay the co-pay. A month later they called to say that they didn’t accept her insurance and she would be responsible for the bill herself. It seems that they accept insurance from the same company, but were not in her network.

When I called her insurance company to seek authorization to see a doctor here, they checked and said there were no doctors in their network within 50 miles of us. There were also no orthopedic surgeons here in their network. Basically, she can travel the 50 or more miles when the need arises or she can return to Philadelphia. I’m still hoping for a special dispensation and should hear something tomorrow. I was also told she might want to look into changing her policy to something better suited to her status and age group.

As to the first doctor bill, I’m working on the basis that they made a mistake, not once but twice, and they should eat the cost of the visit.

The Medicare she has is Part “A” and covers the hospital only not doctors visits. I checked on getting her Part “B”, but they said she had turned it down in 1992 and would now have to pay a 10% penalty for each year since 1993. That means it would cost her over $300 a month just to get Medicare Part “B” now. Did I mention she is on a fixed income? The reason she turned it down in 1992 was because she was still working for the Federal Government and already had a good insurance plan. After that she simply never thought about it again until now. The insurance plan she does have is the same one she had when she worked for the IRS.

When she turned down Medicare Part “B” in 1992, no one told her the benefits or disadvantages. When she retired, the Office of Personnel Management, did not talk to her about her insurance or the option of changing it. She was simply supposed to know these things. Let’s get serious, an answering machine confuses Mom. She is not the questioning, detailed type.  I’ve been trying to find some options for her but frankly, the benefits are not easy to understand. I wish there was someplace I could go to compare different policies from different companies, side by side.

We’ll eventually figure it out, but the insurance companies should make policies easier to understand and our government should start listening to what the people are saying. While I agree we need reform, we need to get there by lowering costs, controlling lawsuits and getting a handle on the cost of prescription drugs. If we can do that, then the premiums will come down and more people will be able to afford their own policies. Beyond that, let the government expand Medicare/Medicaid to all of those who would still not be able to buy a policy of their own, but don’t mess with those of us who are happy with what we have.

Getting Back to Normal, Whatever That is!

Mom arrived safe and sound and we had a very busy weekend. Mom brought a bunch of stuff with her that will take some time to sort out. With my impending surgery, I didn’t feel much like getting out so we sat around the house the entire weekend. Naturally, we got to catch up on all the family trials and tribulations as well as the good stuff. On Monday the 17th my sister, Jean and brother-in-law, Paul returned to Philadelphia, leaving us with the twins, Ashley and Brooke, for a couple of weeks. It was quite an experience having two eight year old girls around.

On Wednesday morning, I went in for the hip replacement. I don’t remember anything until I arrived in my room. The pain wasn’t as bad as I expected and before long they were getting me out of bed and walking down the hall. I was hoping to go home on Saturday but the doctor decided on Sunday instead.

It was a wild week for my wife. One day, Mom had a reaction to her medication and felt weak and sick to the stomach. She vomited most of the day. My grandson, Rylan was particularly fussy and the twins were full of energy. At one point my wife was feeding Rylan, Mom began vomiting and Ashley ran into the house yelling that Brooke feel off her bike and was gushing blood. Delia, handed the baby to me, slid a bucket to Mom and went out to investigate, all without missing a beat. She took it all in stride and within twenty minutes everyone was settled down. As it turned out Brooke had scratched both hands but the “gushing” blood was a slight exaggeration.

On Monday my Physical Therapist, Lee,  arrived to begin the torture. I was also assigned a nurse, Staci, to check on the incision and my general health. On Friday Jean and Paul came back to pick up the twins and go on their “real” vacation in Maryland.

Both Lee and Staci said I am doing great. I used a walker for a week and then went to a cane. Two weeks after the surgery the doctor said I could  shower on my own and removed all the staples. Next Wednesday I can drive and the following Monday I can return to work.

So that brings us up to date. I feel good and the old pain from the bad hip is gone. I still have some discomfort from the surgery, but all in all I’m getting around good. Mom is doing great and her own health is improving since she doesn’t have all those steps to deal with.

In the next several days I’ll get back on track and get back to posting all the other stuff I’ve been waiting to rant about. It’s great to be able to sit at the computer again. Thanks for waiting for me.

Certified Nurses Assistants Are Needed Everywhere

Part of my job consist of finding work for the disabled and work to train the disabled. As such I travel to companies and agencies in a five county area. Naturally, I try to keep up with who’s hiring and therefore stay in touch with local job service offices, Human Resource Managers (HR) and temp agencies.

Recently I was speaking to a representative of the Employment Security Commission, better known as the unemployment office. He stated that things were bad all over, but they were having some luck placing folks in medical and health care positions, including medical administration. It seems that no matter how bad the economy gets people still get sick and need care.

Today I visited the HR manager at a local hospital and was told basically the same thing. She added, however, that there was a great need for Certified Nurses Assistants (CNA). In fact, they were now accepting CNA’s who had been certified out of state and even taking a chance on some who were still working on a certification.

In South Carolina the certification course only takes eight (8) weeks and they even have some accelerated programs you can finish in just two weeks. The problem is not the number of people taking the classes but rather the number able to pass the test.

So if you are out of work or worried about losing your job and and you have ever considered a medical career, now is your chance. If you are unemployed, check with your state employment security office and see about programs available for retraining. Also check with the local community college or technical college. Here they are offering a $1,000 scholarship to anyone who wants to take a nursing or industrial skills course.

Also go to my CNA website at www.nurse-asst.TellMeaboutThat.com and get more information on programs available. Good luck, stay healthy and study hard.