As of yesterday, the official word from Rush University Cardiology and Pulmonology Billing Departments is that they "don't like the signature" on the Gap Exception letter that was used by the hospital and all other providers to process Raj's March stay. That's funny, because they honored the same "signature" on the CHECKS they cashed from UHC.
Raj came back from his sleep study with a new mask to try, since he has a beard and mustache now, so maybe this will help him to keep it on enough to help with the apnea while we wait for the full report from his overnight.
An older gentleman, recently released from the psych ward at NW Community Hospital, has been at Raj's assisted living for a few days, since they didn't know where to put him while awaiting his court appearance. Apparently, he was removed from a domestic disturbance with his wife, and will learn Monday what happens next. Raj insists we must help him, and has been calling several times over the past few days with various requests on behalf of "Don":
"Come and take Don and me to Walgreens. He needs deodorant and Poligrip." 3x
"What is our family lawyer's contact info? Don needs representation Monday in court." 2x
"Bring a printer and a USB drive over here. Don needs to print a letter." 5x
Also:
"Dr. Gardineer says to decrease by Depakote - It's messing up my liver."
Needing a break from Raj's constant wants and needs, the kids and I had a "Girls Night In" last night & blew off some steam. Took me all morning to recover, but it felt good to laugh with my kids!
Saturday, October 29, 2011
Wednesday, October 26, 2011
More of the same
Since I was on with Humana most of yesterday, I spent a good 4 hours with United Healthcare and Rush University Medical Center claims specialists today. Equal time and all that. Instead of measuring progress on getting claims processed and paid, I'm considering measuring by the number of contact points I have within each "inner sanctum" departments at the insurance companies, hospitals & medical facilities. Raj's claims from March 2011 are no closer to being correctly paid; however, today, I got through to both Kiya and Micah within their respective specialists' departments at Rush (through their supervisor), learned both their last names, got their fax number, and Micah's direct email address. I also learned the name of the super-duper secret department at UHC that has no outside phone lines, but is the only way to work claims there - the Rapid Resolution Team. My contacts there grew to both Kimberly (in September) and Robert (in October), no last names are allowed, and they have no fax or email that they'll admit to. Robert made the mistake of asking whether he could help with anything ELSE today, so I even tossed him the Kiya/Micah issues to see if he can work 'em from the UHC side, even though the error lies with Rush Cardiology and Pulmology not honoring their contracts.
Scoring using the new system, I gained 2 in-network providers today for durable medical equipment, including their step-by-step guidance on how these type of claims work (and coverage level) under Medicare Advantage (Humana, which I have for Raj now) vs. straight Medicare. I have their direct phone lines, and the fax number for Raj's PCP to send his prescription.
Regarding outpatient procedures (completely different from doctors, inpatient, DME or anything else), I learned that process from my new buddy, Roxanne, and the Alexian Sleep Health Center. So I'll bring Raj there tomorrow night for another sleep study & pick him up early the next morning before the kids get ready for school. Since his bed is broken, I figure he'll at least get to sleep on a real bed that night!
Raj said the phlebotomist took his blood this morning, ordered by the new PCP, but I don't get any measurable contact-point progress on this, because nobody knows what entity drew/tested the blood, whether they're in-network, who/what they'll charge, whether it's considered inpatient, outpatient, etc.
Our landline caller ID shows more than 50 outbound calls so far today, and 25 inbound, um - make that 26 . . . .
Scoring using the new system, I gained 2 in-network providers today for durable medical equipment, including their step-by-step guidance on how these type of claims work (and coverage level) under Medicare Advantage (Humana, which I have for Raj now) vs. straight Medicare. I have their direct phone lines, and the fax number for Raj's PCP to send his prescription.
Regarding outpatient procedures (completely different from doctors, inpatient, DME or anything else), I learned that process from my new buddy, Roxanne, and the Alexian Sleep Health Center. So I'll bring Raj there tomorrow night for another sleep study & pick him up early the next morning before the kids get ready for school. Since his bed is broken, I figure he'll at least get to sleep on a real bed that night!
Raj said the phlebotomist took his blood this morning, ordered by the new PCP, but I don't get any measurable contact-point progress on this, because nobody knows what entity drew/tested the blood, whether they're in-network, who/what they'll charge, whether it's considered inpatient, outpatient, etc.
Our landline caller ID shows more than 50 outbound calls so far today, and 25 inbound, um - make that 26 . . . .
Tuesday, October 25, 2011
Yes, it can get worse
So Raj calls me late last night - some doctor who said he was a psychiatrist saw him. No name, no card, no change to meds (even though one of his blood levels is too high), and he figures I'll probably get a bill from this dude. In the meantime, I've been calling every psychiatrist in the Humana Choice Advantage network, leaving messages & begging for ANYONE to see him. I receive one of the following answers - not taking new patients, refuse to work with Humana, or they ignore me. I call the nurse at his facility today to get a name on the mystery nighttime visitor, and try to figure a few other things out (e.g. why they gave him another chest X-ray, ignoring the one from June, etc.). The next thing I know I'm on speaker phone, with Raj, several doctors and nurses. In between all their beepers & cell phones going off, I hear various questions & answers, but none of them can tell me whether the "new" psychiatrist is taking Raj as a patient (or if he's in our network) or if I should keep the appointment I finally made for him tomorrow with the only psychiatrist I could find. What DOES happen is that Raj is put on 1 new med, discontinuing 3 others that I just paid thousands of dollars to fill. They've also ordered a blood draw, but don't know what entity is doing it, when, or whether they're in network.
This, all during dinner, while the dog decides she must defend me from the evil phone receiver by barking and peeing on the leg of my chair, the timer is going off, some random delivery is at the door, kids screaming to smash the HUGE spider, and every pre-teen in IL is texting my daughter about homework.
I even spent 3 hours on the phone with Humana this morning, working through error after error, one claim at a time, reciting Medicare and healthcare reform law to "Larry" who must be the only customer service agent who is old enough to understand my questions and concerns - he sounds at least 90, and I don't think he has teeth.
As if all the above drama isn't bad enough, there's a lawsuit now involving my kids' school/district alleging misuse of authority, sexual harrassment, cover-up, . . . which brings up all kinds of horrible memories of my experience as a teacher, and the garbage my mom went through for so many years. I can't believe how fresh it all seems in my mind. I guess I have a lot more to work through from that time of my life.
At least today, the pain in my wrist lessened enough so I could change the burned-out lightbulbs (the CFLs, of course), so I have lights in the entryway and kitchen again!
This, all during dinner, while the dog decides she must defend me from the evil phone receiver by barking and peeing on the leg of my chair, the timer is going off, some random delivery is at the door, kids screaming to smash the HUGE spider, and every pre-teen in IL is texting my daughter about homework.
I even spent 3 hours on the phone with Humana this morning, working through error after error, one claim at a time, reciting Medicare and healthcare reform law to "Larry" who must be the only customer service agent who is old enough to understand my questions and concerns - he sounds at least 90, and I don't think he has teeth.
As if all the above drama isn't bad enough, there's a lawsuit now involving my kids' school/district alleging misuse of authority, sexual harrassment, cover-up, . . . which brings up all kinds of horrible memories of my experience as a teacher, and the garbage my mom went through for so many years. I can't believe how fresh it all seems in my mind. I guess I have a lot more to work through from that time of my life.
At least today, the pain in my wrist lessened enough so I could change the burned-out lightbulbs (the CFLs, of course), so I have lights in the entryway and kitchen again!
Tuesday, October 18, 2011
I'm continuing to heal from my unfortunate up-close-and-personal-meeting with the sidewalk, and can use my wrist for many things, but neck pain has been really bad; So it appears the impact to my neck was a secondary (and longer lasting) injury. The outside bruises have healed on elbow & knee, but I must have internal bruises - is this possible? - since they are still very tender.
I've been having a difficult time securing doctors for Raj's care. Thank goodness we found a good PCP, but finding a psychiatrist in his network AND accepting new patients is taking a lot of work. One of his blood levels indicates problems, but I can't find a doc to address it! Today, the lung/sleep specialist said his apnea looks much worse, but symptoms are confusing, so we need to get him in for another sleep study.
The slats on Raj's bed at Emeritus fell through, so I fixed them with a staple gun; then replaced them with new slats from Ikea. Each of these solutions lasted about 5 minutes. I can't afford a new twin bed, much less deliver/assemble it with my bum wrist & neck, so I'm not sure what I'll do next.
I've applied to several programs for financial assistance, with a wide variety of results: Working with charitable groups, schools and churches is pretty straightforward and fair. We don't qualify for anything that is income-based for our housing, since Raj is on the mortgage - no loan modifications, Illinois Hardest Hit, HUD, federal programs, . . . I can't even refinance! We don't qualify for Medicaid or Extra Help on prescription costs or even AARP/Senior programs. Bankruptcy wouldn't even offset the medical/housing costs compared to our income.
Even though we've met the out-of-pocket maximum to satisfy the infamous "donut hole" with Raj's Medicare prescription coverage, all meds continue to be processed with me paying the full cost! We're supposed to be into "catastrophic" coverage or the final stage of the plan year, but I've had to appeal (sometimes several rounds) to get basic things covered, much less the latest "benefits" of healthcare reform.
The following is a vent - don't read if you're a wimp:
Why are people so naive to believe that just because laws were passed on healthcare reform, the changes will actually take place?! I'm working both private insurance and Medicare Advantage claims, both before and after reform was enacted, and it's nothing short of a nightmare. The only entities holding up their end of the bargain, in my experience so far, is the drug companies. During the donut hole, the drug companies must subsidize half the cost for name-brand prescription drugs, or they can't be a Medicare-participating pharmacy. There are new departments at insurance companies now, simply to add another level of hoops for the insured to jump through to get any claims paid properly (in my opinion). When reform went through, no time limits were adjusted to allow for all the extra processing that claims need to go through under the new rules, so it's relatively easy for the insurance company to tell you that your doctor/hospital didn't submit their claim (or resubmit it with new or corrected info) in time. Another tactic I've run into is no published contact info for the new departments that can actually work the claim. I've had to "work my way" through the phone tree, customer service hierarchy, appeal process, etc. to GET to the new department; In my case, I have the additional step of providing HIPAA doc (POA or whatever each entity requires) to allow me access to Raj's medical info for each department of each hospital/doctor/insurance company I contact; Then it's a race against the clock to reach these folks before time runs out on getting the claim "fixed". The premiums paid for the benefits of this coverage? 300% increase with healthcare reform, whereas it used to increase 10-25% annually.
I've been having a difficult time securing doctors for Raj's care. Thank goodness we found a good PCP, but finding a psychiatrist in his network AND accepting new patients is taking a lot of work. One of his blood levels indicates problems, but I can't find a doc to address it! Today, the lung/sleep specialist said his apnea looks much worse, but symptoms are confusing, so we need to get him in for another sleep study.
The slats on Raj's bed at Emeritus fell through, so I fixed them with a staple gun; then replaced them with new slats from Ikea. Each of these solutions lasted about 5 minutes. I can't afford a new twin bed, much less deliver/assemble it with my bum wrist & neck, so I'm not sure what I'll do next.
I've applied to several programs for financial assistance, with a wide variety of results: Working with charitable groups, schools and churches is pretty straightforward and fair. We don't qualify for anything that is income-based for our housing, since Raj is on the mortgage - no loan modifications, Illinois Hardest Hit, HUD, federal programs, . . . I can't even refinance! We don't qualify for Medicaid or Extra Help on prescription costs or even AARP/Senior programs. Bankruptcy wouldn't even offset the medical/housing costs compared to our income.
Even though we've met the out-of-pocket maximum to satisfy the infamous "donut hole" with Raj's Medicare prescription coverage, all meds continue to be processed with me paying the full cost! We're supposed to be into "catastrophic" coverage or the final stage of the plan year, but I've had to appeal (sometimes several rounds) to get basic things covered, much less the latest "benefits" of healthcare reform.
The following is a vent - don't read if you're a wimp:
Why are people so naive to believe that just because laws were passed on healthcare reform, the changes will actually take place?! I'm working both private insurance and Medicare Advantage claims, both before and after reform was enacted, and it's nothing short of a nightmare. The only entities holding up their end of the bargain, in my experience so far, is the drug companies. During the donut hole, the drug companies must subsidize half the cost for name-brand prescription drugs, or they can't be a Medicare-participating pharmacy. There are new departments at insurance companies now, simply to add another level of hoops for the insured to jump through to get any claims paid properly (in my opinion). When reform went through, no time limits were adjusted to allow for all the extra processing that claims need to go through under the new rules, so it's relatively easy for the insurance company to tell you that your doctor/hospital didn't submit their claim (or resubmit it with new or corrected info) in time. Another tactic I've run into is no published contact info for the new departments that can actually work the claim. I've had to "work my way" through the phone tree, customer service hierarchy, appeal process, etc. to GET to the new department; In my case, I have the additional step of providing HIPAA doc (POA or whatever each entity requires) to allow me access to Raj's medical info for each department of each hospital/doctor/insurance company I contact; Then it's a race against the clock to reach these folks before time runs out on getting the claim "fixed". The premiums paid for the benefits of this coverage? 300% increase with healthcare reform, whereas it used to increase 10-25% annually.
Tuesday, October 4, 2011
Been awhile
OK, let's see if I can catch this blog up:
July was touch-and-go, when Mom developed digestive issues around her fishing trip up north. CT scan in WI, as well as various tests/fluids at the ER locally, got her to realize that a few Ritz and sips of water don't count as sustenance for 10 days. She's adjusted her diet to a plan that works better, and has gained at least a pound back.
Raj was able to receive speech/swallow therapy, where he was taught a breathing technique to help keep him conscious during coughing spells. It appears to be successful, in that he hasn't fallen since the hospital trip in June.
Julie's hamster died 2 weeks ago, so having the dog now eases some of that sorrow. I've learned that it's not a good idea to walk the dog in slippers; Tripped on the sidewalk & fell 9/23, scraping my left elbow/knee, while taking most of the impact on my right wrist. I got my turn with an ER visit, where X-rays found nothing broken, but I'm finding it REALLY hard to have my activities limited while healing.
One of the biggest challenges lately has been financial. When I moved Raj to a lower-cost assisted living facility to offset the additional health insurance premiums, I was making ends meet. Then both tax installments on the land (approximately $10,000, including the annual property insurance) and the infamous "donut hole" for Medicare prescription drugs hit. Add to that the seemingly endless payments to Rush University Medical Center for Raj's March stay, Ruth needing her wisdom teeth out, and the unexpected medical expenses for me - uterine and breast biopsies over the summer, before my unfortunate "fall" - and I'm just not able to keep up. Our savings have been used up, I'm carrying balances on credit cards (for the first time since 1995!), and I can't sell our possessions fast enough!
My kids are thriving, and God always provides, but recent healthcare reform has made my daily life exponentially more difficult.
July was touch-and-go, when Mom developed digestive issues around her fishing trip up north. CT scan in WI, as well as various tests/fluids at the ER locally, got her to realize that a few Ritz and sips of water don't count as sustenance for 10 days. She's adjusted her diet to a plan that works better, and has gained at least a pound back.
Raj was able to receive speech/swallow therapy, where he was taught a breathing technique to help keep him conscious during coughing spells. It appears to be successful, in that he hasn't fallen since the hospital trip in June.
Julie's hamster died 2 weeks ago, so having the dog now eases some of that sorrow. I've learned that it's not a good idea to walk the dog in slippers; Tripped on the sidewalk & fell 9/23, scraping my left elbow/knee, while taking most of the impact on my right wrist. I got my turn with an ER visit, where X-rays found nothing broken, but I'm finding it REALLY hard to have my activities limited while healing.
One of the biggest challenges lately has been financial. When I moved Raj to a lower-cost assisted living facility to offset the additional health insurance premiums, I was making ends meet. Then both tax installments on the land (approximately $10,000, including the annual property insurance) and the infamous "donut hole" for Medicare prescription drugs hit. Add to that the seemingly endless payments to Rush University Medical Center for Raj's March stay, Ruth needing her wisdom teeth out, and the unexpected medical expenses for me - uterine and breast biopsies over the summer, before my unfortunate "fall" - and I'm just not able to keep up. Our savings have been used up, I'm carrying balances on credit cards (for the first time since 1995!), and I can't sell our possessions fast enough!
My kids are thriving, and God always provides, but recent healthcare reform has made my daily life exponentially more difficult.
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