It just never ends - the doctor's appointments, hospitalizations, med changes and medicine orders and reorders. Assessments and physical therapy and home health nurses. Insurance companies - their premiums, their claims. And as soon as I think I'm caught up, there are new symptoms and ... new doctors' appointments.
She is grateful. My sister and brother are grateful.
but I'm just so tired. And - my life keeps getting put on hold. My severance pay will run out too soon, and I'm worried.
Monday, August 18, 2008
Friday, July 18, 2008
Dementia diagnosis - and long term care insurance claim
I've been fighting the insurance company to pay for her long term care in her assisted living facility. At long last, I think I understand the issue, or at least the reason for the delay.
My mother's insurer, Bankers Life, will pay a set amount for her long-term-care if she either (1) has deficiencies in at least two of the six "Activities of Daily Living" (ADLs - bathing, dressing, eating, transferring, toileting, continence, and something else), OR, (2) has cognitive impairment. Mom has some trouble with ADLs, or, what are called Instrumental ADLs (more minor activities that contribute to the ability to live successfully, like, ability to dial a phone), but not enough to merit a claim on her insurance policy. She does, however, have cognitive impairment, diagnosed as Dementia by her physician. In the office, he explained that it was the beginning stages of dementia. Still, a dementia diagnosis = insurance claim, in my mind.
I've been submitting this claim without success. I kept getting turned down. I submitted my form, and the assisted living facility has submitted their paperwork.
I found out, however, a couple things: (1) the assisted living facility did not have a diagnosis from the physician for Dementia. Their cognitive assessments score her as 22 out of 30, where dementia would need a score of 20 - therefore to them, she did not have dementia. Furthermore, (2) if she DID have their version of (full) dementia, she would not be able to live there at all, since she is insulin-dependent and they do not provide that level of nursing care.
Hmm. That explains the bruises on my forehead as I've beat my head on this brick wall.
I did, however, bring the latest Bankers form to the director of the facility, and showed them that they ask whether the DOCTOR diagnosed her with a cognitive impairment. I showed the director the doctor's diagnosis. So, I'm hopeful that the facility can now submit the paperwork that might allow for the insurance claim.
If only I'd known this six, eight, ten months ago. I didn't even know what to ask. It all seemed so obvious to me.
So, we now await the director submitting the papers and the response from Bankers.
My mother's insurer, Bankers Life, will pay a set amount for her long-term-care if she either (1) has deficiencies in at least two of the six "Activities of Daily Living" (ADLs - bathing, dressing, eating, transferring, toileting, continence, and something else), OR, (2) has cognitive impairment. Mom has some trouble with ADLs, or, what are called Instrumental ADLs (more minor activities that contribute to the ability to live successfully, like, ability to dial a phone), but not enough to merit a claim on her insurance policy. She does, however, have cognitive impairment, diagnosed as Dementia by her physician. In the office, he explained that it was the beginning stages of dementia. Still, a dementia diagnosis = insurance claim, in my mind.
I've been submitting this claim without success. I kept getting turned down. I submitted my form, and the assisted living facility has submitted their paperwork.
I found out, however, a couple things: (1) the assisted living facility did not have a diagnosis from the physician for Dementia. Their cognitive assessments score her as 22 out of 30, where dementia would need a score of 20 - therefore to them, she did not have dementia. Furthermore, (2) if she DID have their version of (full) dementia, she would not be able to live there at all, since she is insulin-dependent and they do not provide that level of nursing care.
Hmm. That explains the bruises on my forehead as I've beat my head on this brick wall.
I did, however, bring the latest Bankers form to the director of the facility, and showed them that they ask whether the DOCTOR diagnosed her with a cognitive impairment. I showed the director the doctor's diagnosis. So, I'm hopeful that the facility can now submit the paperwork that might allow for the insurance claim.
If only I'd known this six, eight, ten months ago. I didn't even know what to ask. It all seemed so obvious to me.
So, we now await the director submitting the papers and the response from Bankers.
Sunday, April 27, 2008
April brings May showers but also new diagnosis...
The Long Term Care insurance company declined the first application, not surprisingly I guess (cynical) so we re-submitted with more careful work from the doctor. When we were in the doctor's office (so I could personally oversee his filling out the form), he said aloud her diagnosis - dementia.
Mom's reaction was swift.
"Dementia?" But he explained it very nicely, that at her age, it's the body's way of helping her to let go, to lose track, and with good support around her, it is not really a problem. It's OK to let it happen.
So, she starts to giggle. She LOVED it! As she went back to her home, she stopped people in the halls - some she barely knew - and said, "My doctor just diagnosed me with the early stages of dementia!", accompanied by waves of giggles.
Yep. Exactly so.
And, during April we've had one (or was it two?) hospitalizations. She went in for atrial fibrillation that wouldn't stop. And her cardiac cath, but I think I've already described that.
I finally got a three-month supply of her meds. That will ease the complexity of all these last-minute refills.
She's also had daily low-blood-sugar events. We brought her to an endocrinologist for her diabetes, who adjusted her insulin dosage and asked for more readings of her blood sugars. The 'home' will help administer and log those - at $10 a pop, it will end up at $600 a month, but perhaps we only need to keep that rigid of records for a month or six weeks. But it's worth it - she utterly could not keep track of that many sticks.
I had her out for a family dinner last night with my friends from Colorado and my kids and grandkids. It was loud and raucous and fun - she mostly sat there, interacted when prompted, then just enjoyed being around people. About 7:00 she was ready to go home.
We have discussed getting a wheel chair (for outings, to conserve her energy and speed up the travel) and a walker (for walking outside of the home, since the home has railings everywhere). She was open to it. Now I just have to figure out how to get them (with Medicare). Sigh.
Mom's reaction was swift.
"Dementia?" But he explained it very nicely, that at her age, it's the body's way of helping her to let go, to lose track, and with good support around her, it is not really a problem. It's OK to let it happen.
So, she starts to giggle. She LOVED it! As she went back to her home, she stopped people in the halls - some she barely knew - and said, "My doctor just diagnosed me with the early stages of dementia!", accompanied by waves of giggles.
Yep. Exactly so.
And, during April we've had one (or was it two?) hospitalizations. She went in for atrial fibrillation that wouldn't stop. And her cardiac cath, but I think I've already described that.
I finally got a three-month supply of her meds. That will ease the complexity of all these last-minute refills.
She's also had daily low-blood-sugar events. We brought her to an endocrinologist for her diabetes, who adjusted her insulin dosage and asked for more readings of her blood sugars. The 'home' will help administer and log those - at $10 a pop, it will end up at $600 a month, but perhaps we only need to keep that rigid of records for a month or six weeks. But it's worth it - she utterly could not keep track of that many sticks.
I had her out for a family dinner last night with my friends from Colorado and my kids and grandkids. It was loud and raucous and fun - she mostly sat there, interacted when prompted, then just enjoyed being around people. About 7:00 she was ready to go home.
We have discussed getting a wheel chair (for outings, to conserve her energy and speed up the travel) and a walker (for walking outside of the home, since the home has railings everywhere). She was open to it. Now I just have to figure out how to get them (with Medicare). Sigh.
Friday, March 14, 2008
wow... it's March already...
I've had a few other distractions... work, personal stuff... and things quieted down into a routine. Time to come chat since there has been some news.
About a month ago, my company offered a voluntary separation package as part of a layoff effort. I took it. Just too much to try to handle stress of mom and stress of work. Although mom tends to settle into a routine, the routine is one of a constant stream of neediness. Often small things ... but, 'often' is the operative word there. More on that another post.
Last week, she had a second event with chest pressure, and a second trip to the emergency room. They admitted her, did a nuclear stress test which revealed abnormality, and then scheduled a cardiac cath for the next day. Upon doing that, it revealed a 60% blockage, but over a lengthy area of one artery, and other lesser blockages in others. Just treating with meds.
We ordered the new meds, and they came before I could get there to put them in the pill boxes, so she was going to do it. When I got there, I found that she had doubled up on the Detrol erroneously, but NOT put in the new pills. Sigh.
And, last night I got the results of the insurer's review of her application for benefits for long term care. They denied it. Just said she wasn't cognitively impaired nor was she physically unable to do ADLs. But - her doc said she had dementia.
After I called them, I was told that the doctor's statements lacked some dates, or details. (why couldn't they have just said that? sigh). I will try, try again.
About a month ago, my company offered a voluntary separation package as part of a layoff effort. I took it. Just too much to try to handle stress of mom and stress of work. Although mom tends to settle into a routine, the routine is one of a constant stream of neediness. Often small things ... but, 'often' is the operative word there. More on that another post.
Last week, she had a second event with chest pressure, and a second trip to the emergency room. They admitted her, did a nuclear stress test which revealed abnormality, and then scheduled a cardiac cath for the next day. Upon doing that, it revealed a 60% blockage, but over a lengthy area of one artery, and other lesser blockages in others. Just treating with meds.
We ordered the new meds, and they came before I could get there to put them in the pill boxes, so she was going to do it. When I got there, I found that she had doubled up on the Detrol erroneously, but NOT put in the new pills. Sigh.
And, last night I got the results of the insurer's review of her application for benefits for long term care. They denied it. Just said she wasn't cognitively impaired nor was she physically unable to do ADLs. But - her doc said she had dementia.
After I called them, I was told that the doctor's statements lacked some dates, or details. (why couldn't they have just said that? sigh). I will try, try again.
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