The insurance company has met it's match in me and mom wins . . .

Thursday, April 28, 2011

The insurance company has met it's match in me and mom wins . . .

This is how I am feeling right now.  Zak and I had just left the care center after a long talk with the social worker and the floor manager about mom/grandma.  It seems that we are now entering insurance hell in regard to what happens next.  My God, they don't make it easy.  I admit that personally we have been very blessed to have great insurance through Phil's employer.  Throughout his ordeal with cancer, surgery after surgery, and years of weekly chemo, test after test after test, biopsy after biopsy, hospital stays, home nursing care, then the medications he continues to take we haven't had to pay for anything out of pocket and I can't even recall anything we've had to pay for out of pocket.  I naively went into this with mom thinking the same would be true.


Where oh where is the book that explains all there is to know about health care for the elderly.  Not just elderly, but 93 years old.  It seems that somewhere out in the black hole of insurance land, a 93 year old woman is considered to be past her prime and not really worthy of much medical care.  She apparently has lived a nice long life and it's time to let her go.  Ironically this may be what mom would like to have happen, but it's not going to happen on my watch.  While I will abide and respectfully honor mom's DNR, I will not allow this insurance company to decide she can wither and die at home after May 28th.

Yes, May 28th, exactly one month from today, is the date they have set to cut her off from her insurance.  Her insurance she has had or at least 30+ years and paid for.  She switched to Secure horizons because they promised that aging would be better with them. They would take care of her until the end.  What they neglected to inform us of was that their services would diminish greatly after age 85.  They certainly did not expect her to live this long and have to pay for nursing home care.  Nursing home care is expensive after all and they are in the insurance business to make money not to spend money caring for their clients.  

I consider myself to be somewhat in the know about advocating.  I was a social worker and spent my professional career advocating for women, victims of domestic violence.  What I learned today is that I no squat about elder care and insurance benefits for elders and how to fight these insurance giants.  Where do I even begin?  

The social worker was somewhat helpful, but what it comes down to is that I have to do all the work myself.  Surely there must be a job in here for someone to help families muddle through all this paperwork so it comes out correctly in a timely manner?  If I wasn't retired I could see a new career for myself taking shape, after I learn how to muddle through it correctly that is.  Right now I am taking baby steps, trying to see the light at the end of the tunnel.

There needs to be a book that explains simple step-by-step directions.  Medicare for Dummies.  I filled out the paper work for mom to ditch secure Horizons and go with Medicare which will cover her nursing home care.  As much as I would love to bring mom home, I can't.  Mom is wheelchair bound now and we have 20+ steps going from our mudd room into our home.  There is no way to get mom into the house.  I can't bring her home, so the only alternative is to keep her in the care center.  We hand picked this care center and we are very happy with the care mom is getting and staff.  She is becoming more and more comfortable there and we do not want to move her.

The paperwork has been faxed to Medicare and now I am waiting for them to send me more paperwork to fill out and a list of other information they need from me in regard to mom's financial situation.  All I can think about is the fact that there is exactly one month to get this straightened out before the care center ceases to be paid for mom's stay and they kick her out.  

Kick her out.

The knot in my stomach is growing bigger every day.  I have not stepped on a scale, but I know I'm losing weight because my jeans are loose and my belts buckle tighter.  I wonder if insurance companies care about the stress they put families under.  The only good thing is that mom is totally unaware of any of this strife, and I like it that way.  I like that she doesn't know and doesn't have to worry.  I am here to do all that for her, and do I gladly. That my not be obvious from this posting, but it is simply my frustration showing through here.  Frustration at dealing with an insurance environment that believes it knows what is best for a patient they have never met.  Never spoken to.  They don't even know her name as I am sure she is nothing but a registration number to them.  I want them to know my mom and if that means I tell them everything, then so be it, I will.  

I will not allow mom to be kicked out of the care center.  All those years of advocating for clients has prepared me for this, my greatest challenge.  

I will not let mom down.

The insurance company has met it's match in me and mom wins .   .   .