My 86 year old Dad has been sick for two weeks and is now facing his fourth major surgery in seven years. It seems his gallbladder is bad and full of stones so out it must come.
As he, Mom and I have zipped around to the Gastroenterologist's office, Radiology, Endoscopy and General Surgeon I decided I needed to refresh myself on Medicare rules and regulations as well as get my mind in "help wade through the maze" mode.
I thought I would share my findings in hopes of helping other Kossacks who may be facing similar challenges.
The first and most important hurdle is understanding Medicare and the benefits provided. For example, I thought a physician's office could ask for but not demand Dad's portion of the bill up front. I was wrong about that...
Some doctors and hospitals may require you to pay them your portion of the bill ‘up front.' If so, check that the amount you paid is not more than what is listed on the Medicare Summary Notice. If it is, call the doctor, hospital, or other provider and demand a refund.
By law they cannot charge you more than amount listed on the Medicare Summary Notice. (Note that if you paid less, the hospital or doctor may bill you for the difference, but if you have other insurance it may pay this for you).
Of further importance is understanding that the patient does not owe 20% of the bill in cases where Medicare pays a share. The patient owes 20% of what Medicare allows which is often vastly different from the original charge. As an example, two surgeries ago Dad was billed $245/day for epidural pain relief and daily Anesthesiologist visits to monitor the catheter. However, Medicare allowed much less than that and Dad paid 20% of that figure.
With Medicare parts A and B there are annual deductibles which are paid by the patient as these are applied against visits, procedures and hospitalizations. The tricky part of the part A deductible is that it is per illness.
The Part A deductible for 2008 is $1,024 per illness, and covers the first 60 days of a hospital stay. That is, if you are in the hospital for up to 60 days, you pay $1,024 and Medicare pays the rest of the hospital bill.
If you are hospitalized for more than 60 days, then you pay $256 a day for the next 30 days (days 61 through 90). If you are hospitalized for more than 90 days, you pay $512 a day for each day after 90 days. This is one of the reasons many people carry supplemental private insurance, also known as ‘Medigap' insurance.
Should your elder parent need Skilled Nursing post hospitalization here is the deal...
Note that for a skilled nursing facility, Medicare covers up to 100 days. The co-insurance begins after day 21, and is $128 per day.
Are you dizzy yet?
These are some helpful links about Medicare:
http://www.medicarebenefits.com/...
http://www.medicarebenefits.com/...
http://www.medicarebenefits.com/...
http://www.medicarebenefits.com/...
In addition to being up on the rules and regs I have found issues that need attention that are anecdotal in nature.
My folks both wear hearing aids so it didn't occur to me they would have a problem hearing what was being said to them. They did have trouble due to so much background noise in waiting rooms, soft spoken nurses and techs and physicians in a bit of a hurry speaking "medical talk" rather than what they could understand. Had I not been with them I would have little idea what the situation is so I now know that if I cannot accompany them I will find a friend to help out.
Older people (at least the ones I know) still have the "Doctor is God" mentality and therefore feel they shouldn't ask questions. I can't budge them from this, they think to ask questions would be rude! So again I say, if your elderly loved ones need medical care and you can't go with them, "phone a friend"!
Everyone entering a hospital should do so with a Healthcare Power of Attorney. If not one of these then at least a Living Will. The difference between the two is the extent to which they each go in carrying out the wishes of the patient. A Living Will form can be obtained at the hospital or even online and the Healthcare Power of Attorney can be obtained online or prepared by an Elder Law Attorney.
In summation, know your loved one's rights, do what you need to understand the Medicare rules and regulations, ask questions, speak up and advocate for your parents. The present health care system is such a challenge to navigate they'll need your help from getting a diagnosis to finishing the last pill in the prescription bottle.
If I am incorrect in any of this information please correct me in the comments. It's so good to share our knowledge and help each other deal with this increasingly tough issue. Best of luck to us all!