| Author | Message | ||
     Cynicalgirl Citizen Username: Cynicalgirl Post Number: 1345 Registered: 9-2003  |
I took care of my parents' medical matters. Bills kept coming a year after each was disceased. And, sometimes they change the account number on you if, say, your mother's spouse is alive when the treatment starts, and then dies. What a cluster! With my husband's, I kind of let them age in the drawer for a couple of months if they're over a couple of hundred dollars. Make sure the kinks get out between the insurance company and the "service" provider. | ||
| Debby Citizen Username: Debby Post Number: 1833 Registered: 5-2001 |
g-you're so right about usual and customary. One of my kids recently needed a neurological workup at a leading research hospital. Aetna said they'd reimburse $56. I could just laugh. P.S. Thank God - everything was fine. | ||
| greenetree Supporter Username: Greenetree Post Number: 4294 Registered: 5-2001  |
The night before last, I got a distressed call from mom. Her friend who is to stay over on Wednesday night has a cold sore. Her FAQ sheet says to avoid people with cold sores. Should she get someone else? Mom, are you planning on making out with her? Sleeping with her? Sharing a toothbrush? Etc., etc. Then you should be OK. So, yesterday, she asks her oncologist the same questions. He says "are you sleeping with her? Then it's OK. Just don't kiss her or share a fork". She tells him "that's what my daughter said". Drum roll, please..... Moment in history.... He said "she's right". She's right! hahahahahahahahaha Whose the nag, now?????? nyuck nyuck nyuck. Sorry - just had to get that out of my system. I can't remember if I mentioned this before, but we found out last week that mom wasn't taking her anti-nasuea meds because it knocked her out to much to deal with Maniac Devil Dog. Once I sent him to the farm, she 'fessed up. So, I just get a call from Normal Sib. He's there to help today and tomorrow. I had suggested to her that if she felt up to it, she should have him stop by a greenhouse on the way home from chemo to buy annuals & I'd plant her garden for her on Saturday. Now, last week she wasn't supposed to be around live plants because her white count was so high. This week, she is allowed. But, Brother doesn't know this. Hence, the phone call. "Is she eating dirt"? I ask. Well, then. OK. Just tell her not to touch the plants & wash her hands before you leave the place. (I'm going to ride her doc's words for awhile...  ) I ask him how it's going. "OK", he says, "but we had a fight in the car on the way here from chemo". What happened? Apparently, he realized that the only plastic bag he has in his car has a hole in it. And one of mom's friends called while they were in the car and reminded mom that she puked on the way home the last time. So, given the holey bag issue, the friend told my brother to roll down her window. It is apparently a bit chilly out today. Mom said she was cold, so they couldn't agree on whether he would put up the window or she would wrap up in a blanket. Glad to know she's feeling well enough to argue. If she gets on my nerves this weekend, I know where to put her..... Vinny & Rob's backyard. I hear it's quite the spot for do-it-yourself burials. | ||
| VinnyM Citizen Username: Frodo Post Number: 94 Registered: 3-2002 |
 I hope everything goes well this weekend. | ||
| Spare_o Supporter Username: Spare_o Post Number: 235 Registered: 9-2003 |
The recently enacted federal HIPAA regs allow for patients to have their insurance-related correspondence directed to an alternate address. You could have that mail sent to you, however, this won't halt the avalanche of mail generated by all the doctors, labs, ERs, bed pan changers, etc. Your mom would have to call her insurance company to make the request. | ||
| greenetree Supporter Username: Greenetree Post Number: 4297 Registered: 5-2001 |
Spare - I have all the HIPAA forms on file already. I just felt it was better for everything to stay in Ohio, since my brothers & I all come and go so regularly. In case something happens to me, they can get their hands on it. I just want her to stop opening it. Nornmal Bro just called to ask me what he should feed her. She's in the background yelling that she's not hungry. I feel like I have a... what age child would this be? I told him that if she keeps chicken soup & toast down, she can have a milkshake. So much for never wanting children....  Spare-o reminds me of a good point, so please stay tuned for this important message from our sponsor: Case Management. If you are covered by a managed care plan, your plan has a case management department. If you have a child with asthma who has gone to the ER for asthma treatment, you know this already, because they've called you about an asthma program (probably). Most people don't think about it. But, if anyone in your family is ever diagnosed with a serious or chronic illness that is going to be a high-use condition, demand that they be enrolled. You generally won't be told about this unless you trigger a flag somewhere, but you don't want to wait that long. Case management nurses are really good at what they do and care about the patient. They aren't about the cheapest care, but they will work to find you care within coverage. They can also ask the Medical Director to intercede if you need to go out of network to get something covered. It's pretty much like having an advocate on your side. BTW - all managed care plans also have patient advocates. Example - I found out that in order for my mom to be enrolled in case management, she would need to be referred by her PCP. I did not accept that and asked for the patient care rep's number. She in turn, had the Medical Director call me. I explained to him that I wanted her in case management before there was a crisis. He had a nurse call me. Within 48 hours, she had a file. So, earlier this week, when we had issues with her catheter and she needed a home health aide visit, I picked up the phone and called the case manager. Within 24 hours, mom had her visit. The day after that, the agency that went thru the regular referal route from her oncologist called to set up an appointment. Too late; it was done. Don't worry that your family member doesn't need it "yet" or that it's going outside of the process. Demand it and use it. This goes for CHF, anyone who has had a heart attack, cancer, diabetes, etc. Commercial over! | ||
| Spare_o Supporter Username: Spare_o Post Number: 236 Registered: 9-2003 |
Greenetree is absolutely right about case management. I used to work with a company that did case management. I was on the business side but it was one of those jobs when I felt very tied into the mission of the company and what I was doing was, even a bit indirect, helping people who really needed it. It's incredibly easy to get lost in "the system" and having an advocate is analogous to a lighthouse in the fog. | ||
| greenetree Supporter Username: Greenetree Post Number: 4310 Registered: 5-2001 |
Off topic - There has been this horrible smell (like BO) in the restroom on my floor at work for weeks. Many maintenance guys have been up, building services clucks their tongues at this unacceptable situation. A solution has been found. There is now a large basket of over-perfumed, flowery potpourri in the restroom. I'm not sure which is worse; one makes me gag, the other gives me a headache. Perhaps I should incorporate more exercise into my personal moments and walk up to the rest room on the next floor. Called mom to see how she was feeling this morning. She and Normal Bro were fighting over who would take the first shower. It was a very short conversation. I have this vision of two funky, smelly people sitting around in a pajama stand-off. I hope they don't miss chemo. | ||
| Cynicalgirl Citizen Username: Cynicalgirl Post Number: 1355 Registered: 9-2003 |
I was talking with a co-worker about medical stuff as he used to work for various medical related insurers. He explained the in's and out's to me of capitation and the like -- and how it relates to whether or not certain services are offered. Example: hospitals and therefore surgeons are rewarded for shorter stays and going the outpatient route. It's understood that this strategy means more outpatient services like visiting nurses, primary care visits, case mgt and so on are likely to be needed. But, this stuff is ultimately cheaper. On the other side of the equation, if your insurer offers visiting services and such, the organizations they affiliate are also begin reimbursed via some sort of capitation. It is therefore not in their interests, either, to offer you services -- though they can't refuse if you request or your dr requests. What a freakin' mess. I had wondered, over the years, why I was being encouraged to learn how to care for deep wounds, ostomy matters and post surgical incisions and the like. Duh! Seems like there's a whole new job out there, for which greenetree and I would be well-trained. Kind of like "medical services advocate." Or, call it healthcare manager. It sure ain't coming from anyone officially in the loop. IT's what we do in our spare time. | ||
| Cynicalgirl Citizen Username: Cynicalgirl Post Number: 1356 Registered: 9-2003 |
I am, BTW, quite serious about the above. I begin to think it would be worth well-heeled's while to hire a sort of a medical lawyer, someone who was up on the plans, what they meant, one's entitlements. There is no one in the equation who truly sees to your needs. Why not? We hire lawyers for various transations. We hire accountants for taxes and similar. Why on earth wouldn't we think about hiring a professional to deal with our health care? | ||
| Spare_o Supporter Username: Spare_o Post Number: 237 Registered: 9-2003 |
I used to negotiate contracts for a health plan in CA. When I transferred to NJ and worked in the same area, I found that capitation was not so widespread in the Northeast. It varies by plan and certainly the economics of health care has changed since the mid-90s but I would be a little surprised if there was widespread capitation in this area for many or most specialties / disciplines and levels of care. In CA, everything was captiated, including hospital stays. Incentives were in place to attempt to address quality of care issues but there definitely was more responsibility placed on the patient and family in many situations. In my opinion, capitation is, at least in part, the result of the defensive medicine and medical malpractice lawsuits that have become much more common since the 70s. I don't endorse capitation but am extremely familiar with a fairly sophisticated model used by CA health plans. While it makes sense on paper (move risk to where it can be managed best, at the physician / hospital level), there are unintended outcomes as Cynicalgirl describes. | ||
| Cynicalgirl Citizen Username: Cynicalgirl Post Number: 1357 Registered: 9-2003 |
Thanks, Spare_o. Good to know I'm not crazy, or inappropriately cycnical. Seems to me if each "care" provider in the equation is paid an amount per head (one way or another) it will always be in each node's interest to avoid offering services that might be considered non-critical. And shove them off to the patient/family. And then there's things like classifying Ensure like products as something the patient should pay for even if required due to tube-feeding. Hey, it's not a prescription. Had quite the long fight with Cigna over that on my mother's behalf. It all suxx. | ||
| Cynicalgirl Citizen Username: Cynicalgirl Post Number: 1358 Registered: 9-2003 |
Prepare for a whine. I'm very unhappy today. I am unhappy because my husband weighs roughly 140 lb. On January 2 he weighed 195 lb. He was a few overwieght. He is drawn, scrawny, weak. His skin hangs on him in ways you typicallyl I see on the elderly. He is 54 He has virtually no fat layer -- you can feel his bones. I have stopped buying smaller sized pants because I don't know where it will end. Two weeks ago, I took out as big a loan against my 401K as I could to try to see us through till November. Our family budget, which is modest, is short by at minimum $1,400 per month to cover basic bills. He had worked free-lance and is not eligible for unemployment. After I finally file/pay the taxes, I will see if he is eligible for gov disability but somehow I suspect not if it's means-based. In theory, we can live in this godforsaken state on my income. 'Course we'd have to sell our modest house and go I know not where. I am leveraged to the hilt. We have no family anywhere with any money to help. If things don't change by December I will need a second job or to get the hell out of NJ somehow (job finding etc.). But, truthfully, it's not just the money. It's that I cannot see a light at the end of the tunnel. Our family life is in the toilet, nothing is as it was. The tinyest ordinary dreams that we had, like taking our kid to see Disney World, are impossible due to money and his health. We do nothing. I work hard, keep the house tidy, do some motherly things. A friend from Delaware called up to invite my daughter to go with them to Disney World in June. I cried my eyes out, had a fit around the house. I try to be grateful that my husband is still alive, can still drive, pick her up from school. But, I gotta tellyou kids, sometimes this feels impossible. Please. Before you act on the impulse to tell me to find a stinkin' support group or anything at all, halt. I am venting. Period. I do not want to sit around with a bunch of cancer caregivers and whine. I want nothing less than my husband's health restored, and I want it now. Right now, any higher being or similar can just shove it. I want what I want and that is that. So there. | ||
| Joan Supporter Username: Joancrystal Post Number: 5527 Registered: 5-2001 |
Cynicalgirl: Been there kind of. I was at work one day when I got the call from a hospital emergency room near Rochester, NY that I better get on a plane right away if I ever wanted to see my husband again. The emergency room person told me that my husband had suffered a massive heart attack and wasn't expected to survive much longer. I called back as soon as I made it home and they asked if I wanted to speak with him. The stubborn man had heard that the emergency room staff had given up on him and through sheer will power he had made it past the first crisis. By the time I made it to the hospital the following morning, he was lecturing the hospital staff on how to treat his diabetes. It was great to see him alive but we still had to get through the cardiac surgery and the recovery period. Somehow he made it, our son and I made it and you and your husband will make it too. One of the things which really helped my husband was getting together with two of his friends (one cancer patient and another who was recovering from heart surgery). They really kept each other going. I think that support group was much better for us than any I could have gotten for myself. | ||
| Cynicalgirl Citizen Username: Cynicalgirl Post Number: 1359 Registered: 9-2003 |
Thank you, Joan. Sometimes it's hard to be plucky, or even angry in a clever way. Right now I am just nuthin' but PO'ed. Going to the Pathmark helped... | ||
| Joan Supporter Username: Joancrystal Post Number: 5528 Registered: 5-2001 |
No one expects you to be plucky, angry, or clever but you do need to find your own way of getting through this. Having someone to talk it all out with helps enormously. Plus, it is a lot easier to face all of this in retrospect than when it is actually happening. | ||
| greenetree Supporter Username: Greenetree Post Number: 4315 Registered: 5-2001 |
Pathmark helped???? Whaddja do, smack someone? Sorry you are having such a bad day, week, month, time. I spent the morning packing the dishes at grandmotherf-ers house this morning. I know it had to be done, but I still have an awful headache. My mom is furious, and rightly so. But, if we need cash to help finance something while mom is not working, I gotta do this. I managed to tune her out, except for when she stopped to question whether I really need any of the nice things since I'm not getting married and can never have children and won't have anyone to pass them on to. Then, she said OK, but if I sell them, she gets half. Yeah - she'll get half, all right. I'm gonna give her 50 cents and tell her I sold them for $1 on eBay. God forbid she should say "sell these and use the money to pay for something that your mother's insurance won't cover". Omm, omm. Eyes on the prize, Greenetree.... | ||
| Cynicalgirl Citizen Username: Cynicalgirl Post Number: 1360 Registered: 9-2003 |
I'm so mad I'd like to drive around town and shoot paint balls at "Be About Peace" and political signs. I just can't stand anything uplifting and PC at the moment. I don't give a crap about politics or anything nice right-thinking people are thinking about. In the Pathmark I feel like I'm in amongst the world's strugglers. In King's I feel like an imposter. In WholeFoods, well... Guess I'm in an Irvington state of mind. Look, I'm just a mass of conflicted crap right now. It will no doubt pass by tomorrow. Even I have my limits. Meanwhile, I've mowed the front and backyard, grocery shopped. Been to the drycleaner's. Done 4 loads of wash. Vacuumed. Cleaned 2 toilets and sinks. So I can have a nice, tidy mother's day. Yeah, right. | ||
| Debby Citizen Username: Debby Post Number: 1843 Registered: 5-2001 |
cynical -how awful to watch your husband grow emaciated. I really feel for you. Don't worry about keeping us entertained - vent and vent until you're feeling lighter. And if shopping and cleaning keep the demons at bay, do that, too. I'm so sorry for your situation. | ||
| Cynicalgirl Citizen Username: Cynicalgirl Post Number: 1361 Registered: 9-2003 |
Sorry, guys, for yesterday's hijack. As expected, better today. Back to your regularly scheduled programming! |
