New! 3GenFamily.com – Our New Website Is Now Live

By CK Wilde for 3GenFamily Blog

3GenFamily Blog has moved to a new location on the web.

Please come visit us at 3GenFamily.com

Long Distance Caregiving for a Parent While Raising Teens and Balancing Work and Home

The past 16 months has been an amazing and eventful time for me as a long distance caregiver for my 83 year old father, parent of two teen boys, spouse and juggler of work and home life. When I started this blog, I had no idea I would meet so many dedicated and fascinating people also working to get the best information into the hands of readers like you.

Because there is still a huge need for real answers to many of life’s toughest situations, I am expanding this blog to meet those needs. While I am grateful to WordPress.com for having a perfect place to start a blog, it is time to move to our own website.

I’ll be offering you even more honest content and real life ideas that work for caregivers, parents and anyone struggling to balance the conflicting priorities of work and home life.

Please come visit us at 3GenFamily.com

One housekeeping note: If you signed up to receive this blog via email or RSS from Feedburner, you will need to sign up again at 3GenFamily.com. I am sorry for the inconvenience. There isn’t a way for me to just move your settings over to the new website.

Don’t miss a single post. The latest post discusses 110 Tips for Getting Into the College of Your Choice.

Please come visit us at 3GenFamily.com

Articles on Reducing Conflict with Adult Siblings, Getting Into the College Your Child Dreams About, Surviving Long Distance Caregiving

I will be writing more of the types of article you have come to expect from 3GenFamily Blog. And, there will be new features based on requests and comments I have received from our readers. The topics will still relate to being sandwiched in between two generations — our aging parents who increasingly need our help and our children who are not yet ready to fly into the world.

Somewhere in there, each of us also needs to make a space for ourselves for meaningful work and for celebrating life’s small and large personal successes. Buried between the lines is the emotional turmoil of conflict with our adult siblings and the the lack of understanding of bosses and coworkers who haven’t reached these stages of life.

How do you explain an issue to someone who has no frame of reference?

Please come visit us at 3GenFamily.com

Best Regards,

CK Wilde

© 2008 CK Wilde. All Rights Reserved. Please feel free to link to this post but you must have prior written permission to reproduce this post either whole or in part. Please use the comments to request permission.

Medicare Part D – Open Enrollment Ends Dec. 31- Don’t Miss It!

What’s all the fuss about the Medicare Prescription Drug Program?

Open enrollment started on November 15th and runs to December 31st. This is the time when anyone can change from one plan to another without paying a premium penalty. If your parent is already enrolled in a program, you may be wondering why you need to worry about this.

Medicare and health care advocates in every state are trying to get the word out that the rates are changing. There are major rate increases coming to the most subscribed plans, while some of the smaller plans are decreasing rates. Here in California rates in some plans are increasing by 31%.

All seniors should reevaluate their Medicare Drug plans to see if it still makes sense to stay where they are.  They can check Medicare’s website for help with choosing a plan that covers the specific prescriptions that they need at a cost they can afford. It is important to do it now before the enrollment period ends.

Can there really be that much of a difference?

Yes.

This year doing nothing could be very expensive for your parent. Monthly premiums could increase substantially. Or, you may discover that required medications are not covered by your plan. 

And, of course, there is the highly confusing problem of the “donut hole.” I don’t know who invented this “cute” name but it is a gap in coverage that can take a lot out of your pocketbook.  Here’s how it works:

You enroll in a plan and pay a monthly premium. You pay for your prescriptions until the deductible is reached. Once you have met the deductible of $265, the basic prescription drug plan will pay 75% of your drug costs and you will pay the remaining 25% until your total drug costs reach $2,400.

Then, you are responsible for 100% of your drug costs between $2,401 and $5,451.25. This gap in coverage, the “donut hole”, requires that you pay $3050.25 out of your own pocket before Medicare pays any more for you.

While this is happening, you are still paying your monthly premium. If you get to December 31st without going past $5451.25 prescription costs, there is no additional help. You start the new year meeting the deductible again.

Once your total drug costs reach $5,451.25, the basic prescription drug plan will pay 95% of your additional prescription costs and you will pay up to 5% (or a small co-payment) of your remaining drug costs for the rest of the calendar year.

Each insurance company that offers Medicare Drug coverage has the option to add benefits. Each company can also determine which drug they will or won’t cover. Some companies will pay for certain generic drugs during the coverage gap while others pay nothing.

There are so many plans, with different options,  that vary from state to state, that you need to evaluate before you sign up.  It’s just plain confusing!

Fortunately, every state has Health Insurance Counseling and Assistance Programs. You can find someone in your area to provide free counseling about the plans that would be right for you. You can attend workshops on choosing the best plan.

Before you contact the Health Insurance Counseling and Assistance Program in your area, it’s a good idea to figure out your total drug costs for the past year and make a list of your regular prescriptions so you can compare it with the list of approved drugs for each plan.

It’s work to do this, I know. It is so tempting to just stay with the plan your parent already has.

Don’t do it! Make time now for your parent (or yourself) to find the best plan that is available. You’ll be glad you did.

How To Help Your Aging Parents – Medical Billing

3GenFamily Blog has moved to a new location on the web.

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By CK Wilde for 3GenFamily Blog

It wasn’t until Dad mailed me the collection notice that I realized he was losing his ability to track and pay his medical bills. He had complained during our phone chats on several occasions that the hospital had messed up his billing. They kept phoning him to get him to pay his bill.

He insisted that he had paid the bill– $124.34. The hospital billing staff asked him to send a copy of the cancelled check. But, Dad adamantly refused to go through the work of getting the cancelled check. It was the hospital’s mistake for losing the payment.

I was dumbfounded by his vehement refusal to deal with a straightforward problem. Ironically, in his younger days, my father had been a stickler for financial details. As a young adult, I would have gotten a scalding rebuke for failing to take action on something like this.

His unusual behavior was a warning that his dementia was beginning to impair his judgement, while his anemia left him so fatigued that even a trip to the bank seemed like an overwhelming task. I didn’t recognize it for what it was. I thought he was just being obstinate.

Being 3000 miles away, I tried to get my father to read his checkbook to tell me the check number for that hospital bill. Then, I went online to see if that check had cleared. The check number he gave me had been cashed but it wasn’t anywhere near the correct amount for the bill. I looked for another check with the amount $124.34. I didn’t see any in that month that matched.

I told my father that the only thing to do was pay the bill. He refused. No amount of reasoning worked. So I made a deal with him — I would pay the bill and he would reimburse me.

Grudgingly, he agreed.

My father had already signed a power of attorney giving me the authority to handle his finances and one for health care, too. So, I began learning first hand about Medicare, supplemental heath coverage and prescription drug benefits.

Dad had to sign a form to allow me to access his online medical insurance claims and to speak for him to the insurance representatives. I left instructions for them to phone me first since Dad’s hearing was poor.

I paid the bill. Dad eventually reimbursed me. The collection notices and phone calls stopped.

It wasn’t until a couple of months after my father’s death that I found the entry in his checkbook. Dad was right all along. He had paid the hospital within days of receiving the bill. But, he was so certain he remembered the correct check number that he never looked it up. I was too far away at that time to double check it myself.

The story doesn’t end there.

Another billing mistake almost happened today. I started to pay a doctor’s bill for my father’s estate and discovered that it was more than it should have been.

The doctor is supposed to bill Medicare first. After Medicare determines what it will pay, the doctor sends the bill to the supplemental insurance.

Only after the supplemental insuror has completed the claim, should the doctor bill the patient for any balance due. But this latest bill didn’t show any payment from the supplemental insurance, so I checked the online claims information.

The supplemental insuror had rejected the claim because documentation was missing. Well, sometimes paperwork does get lost. You need to follow up to get another copy sent.

I called and spoke to the medical billing person in the doctor’s office. She pulled up the records on her computer. She stated that my father owed this amount of money. I asked if she sent it to the supplemental carrier.

She said, “Yes.” And promptly read my father’s account number for the insurance.

I asked her, “Why do the online records say your claim was rejected for lack of documentation? The amount you are billing doesn’t appear to include any payment from the supplemental insurance.”

People do make mistakes (including me). Where there is an honest mistake, you can hear the surprise in the person’s voice. “How did that happen?” Sometimes, they laugh self consciously.

There was no surprise in this woman’s voice. There was no admission of a mistake. “We understand your concern . . . we will make sure it gets handled.” She was billing my Dad for the entire amount rather than resubmit the bill to the insuror with the information that was needed. Efficient but totally lacking in ethics.

I wish I could say this was the only mistake I have found. Unfortunately, billing mistakes have happened so many times in the past 9 months of settling my father’s estate.

How many elderly patients pay too much because they don’t have the patience or focus to follow up?

If you have been wondering how you can help your aging parents, discuss helping them with tracking medical bills. Have your parents collect everything (bills, medicare statements, supplemental insurance statements) in a folder. Set up online access to insurance if its available. Make a regular date to go over the bills each month before anyone writes checks.

You may need to make phone calls for your parents. Be aware that privacy rules prevent the insurors from talking with you about your parents’ account unless your parents have given permission in writing.

You’ll be providing peace of mind and possibly saving money for your parents, too.

Update on Unexplained Anemia

What do you do when anemia keeps coming back?

In a previous post on Anemia, I talked about my 84 year old Dad’s recurring problem with fatigue and anemia. He (and I) thought the doctors had found the problem and taken care of it with medical procedures to stop the bleeding, most recently in his bladder,  and by making changes to his regimen of nine medications.

I was so relieved that the bleeding has stopped! Several units of blood later, my father was starting to look and feel a bit better. His kidneys were failing, though. He would need to start dialysis right away and he was willing to try it.

I believed that Dad could now start to recover some quality of life. For most of his over 40 life, he has been able to bounce back from serious illness with a determination that was ferocious at times. As nervous as I was about his current fragile condition, I felt confident that he would gradually get better like he had in the past.  

And, at first, it appeared that was happening.

Dialysis is an amazingly complex procedure for life support that involves the dialysis machine, doctors and nurses to monitor your blood and provide the right medications (such as Procrit for his anemia), and counselors and dieticians to help you adjust to a new lifestyle. And, Medicare pays for a substantial portion of the costs. It seems like a miraculous new lease on life when your kidneys are failing.

Day by day, Dad seemed to be getting better. He mostly slept through the four hour treatments three days a week. Our phone conversations centered around making the arrangements for my father to leave the skilled nursing home where he was staying. He was tired of being poked and prodded. He just wanted to go home.

But after a few weeks, his condition began sliding downward again. He wasn’t interested in talking on the phone. The confusion and delerium which had plagued him when his kidneys failed came back worse than before.

I spoke with the nurses at the dialysis center. Were his blood tests showing any imbalances? Not really. His electrolytes were within normal range. My father’s red blood cell count was low but seemed to be improving. They were watching it closely. He shouldn’t be having these symptoms but he was.

A few mornings later I got a phone call from one of the nurses at the nursing and rehab facility. They rushed Dad to the hospital. I got on the first available plane flight to be at his side.

In the ER, they doctors determined that my father had a massive urinary tract infection along with extremely low blood sugar (he is a diabetic) that made him unconscious.  He was admitted to the hospital, again.

Once admitted, the doctors ran through a series of tests including a routine chest xray. In his review of my father’s chest xray, the radiologist noted a pleural effusion, an accumulation of excess fluid in the space surrounding the lungs.

The lung specialist called in to consult with Dad’s regular doctor told me there were three main causes of this excess fluid: congestive heart failure, bacterial infection or a tumor. He would draw a sampling of the fluid to have it analyzed.

I spent an agonizing weekend waiting for the test results.

On Monday morning, the doctor reached me on my cell phone as I got to the second floor of the hospital. Test results showed the cells were abnormal – lung cancer.

So, we finally had the answer to the anemia that would not go away. Various tumors are hemolytic. They destroy red blood cells.

Now, Dad’s choices were limited and the outlook bleaker than ever.

I was grateful to have an answer that finally made sense because now I knew what I needed to do.