In a world of increasing health care problems, with elder care and caregiving growing perhaps as fast as gas prices- having good health insurance means a lot more now than just having a low copay. It’s clear that the kind of health insurance you have has a huge impact on the the kind of care you receive. But what defines “great health insurance”? And nowadays is having even the best insurance enough?
My mom worked as a R.N. for the city for over 17 years. I had always heard from both her and her coworkers that “they had the best health insurance”. When my mom suddenly became sick, I assumed that her insurance would cover all her needs and that she would receive the best possible care. Reality first set in early on when my mom was in an acute rehabilitation hospital receiving treatment for a stroke. The Case Manager met with me to discuss her benefits and specifically how long her insurance would pay for treatment. Even her Case Manager said her coverage was in fact “as good as they come”. With stroke, like many other illnesses, frequency & longevity of treatment can play a big role on how well a person can recover. In short, my mom’s insurance policy would cover the following:
-60 Days in an Acute Skilled Nursing Facility
-60 Days in a Long-Term Skilled Nursing Facility
-120 Days of Home Health Care
-60 Outpatient Visits
Great! This coverage sounded good to me. I felt instant relief! Sounds too good to be true, right? Well, it was.
Just because your insurance says it covers a certain amount of treatment- doesn’t mean that’s what you will get. For my mom, she only spent 60 days in a rehab hospital “skilled nursing facility”, when she was covered for 120 days. Was she recovered? No. Did she still need treatment? Definitely! So, where’s the discrepancy? The hospital team (doctors, nurses, case managers, therapists) have to report on a daily or weekly basis back to the insurance company on a patient’s “progress”. Insurance companies will only approve care based on their determination of “progress”, not the doctors.
According to my mom’s insurance, her “maximum progress” meant she was able to “transfer” herself from a wheelchair to a bed and she needed “minimal” assistance getting dressed. I panicked! At the hospital, there was a whole team to help her. Who was going to all that now? ME. So, when she came home (after I had made the whole house wheelchair accessible), I became a team of doctors, nurses, aids, and a homemaker. I helped her shower, get dressed, cut food, give medicine, take blood pressure- honestly, the list is endless. Did the insurance company know about me??? What would have happened if I wasn’t there? Basically- one of two things- you could hire someone to come into the house (all out of pocket of course) or the state could deplete her assets (house, savings, everything) and she would be put in a home.
My mom continued treatment with occupational, physical, and speech therapy- at first in home and later in outpatient. My battle continued with her insurance cutting her off due to “maximized progress”. I really endlessly could go on about this but the end result is pretty much the same. As far as I am concerned, there really is no blame here on any of the doctors, nurses, therapists, etc. They get just as frustrated by the system as I am- and they expressed that to me too many times to count.
My point to sharing this story is- firstly, look closely at exactly what you and your loved ones insurance reallycovers. And secondly- look into getting “supplemental”, specifically long-term care insurance. I know it’s an extra cost and it may be too late for the one you are caregiving for but it still may be an option for you and the rest of your family. One thing is for sure, it’s good to be prepared for the worst, before it happens. As the old saying goes- “Hope for the best, but prepare for the worst”.
Good day! This post could not be written any better!
Reading through this post reminds me of my good old room
mate! He always kept talking about this. I will forward this post to him.
Pretty sure he will have a good read. Thanks for sharing!
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Nice! It is very helpful and informative blog, i really like this, i was looking for these kind of blog. Thank For sharing us!
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I am honored to announce that next week I will be giving an online seminar as part of National Invisible Chronic Illness Awareness Week.
My seminar, “Secrets of Paying for Health Care,” will start at 5:30 p.m. Pacific Time (7:30 p.m. Central Time and 8:30 p.m. Eastern Time) on Monday, Sept. 8. It will last approximately 45 minutes and include new information not found on my blog or in the latest version of my book, Unmasking a Diagnosis: How to Find Help for a Confusing Illness Without Filing for Bankruptcy.
National Invisible Chronic Illness Awareness Week, Sept. 8-14, is a secular event sponsored by Rest Ministries, the largest Christian organization that serves the chronically ill. Activities for the week will take place on the event’s web site, http://www.invisibleillnessconference.com. Registration information can be found on the site.
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I hope your Mom is on the road to recovery.
Health insurance is such a complex issue. And the answers are different if you are part of an employer’s plan or an individual plan or on Medicare/Medicaid.
My sister-in-law recently had back surgery. she was faced with the same problem of being released before she was fully walking. Her other sisters valiantly pitched in to help.
But, the biggest problem seemed to come from not really understanding what he insurance covered and what options were available. Most folks don’t look at their insurance until as medical crisis hits.
CK Wilde, 3GenFamily Blog (www.3GenFamily.com)
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I loved the post. I think your thinking is nearly matching the great sukrat’s cocept.
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Sara…
Another thing I never even thought of….I am adding it to my note book….Supplimental Insurance…
Thank you for posting this…
Barb
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SO true we are reviewing mom’s stuff now before we have to make any more decisions. I will be caring for her at home until I no longer can do it. I know all too well what is involved as
it will be a long road to travel. I only hope my health holds up long enough to get by. Supplemental is the only way to go. : )
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It sounds like her health insurance covered exactly what it promised. And getting supplemental insurance would only have paid co-pays and deductibles. It would not have paid after the regular health insurance stopped.
The only insurance available for all of the in-home care your mother needs is long-term care insurance. It picks up where health insurance leaves off.
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We need HR676 SINGLE-PAYER HEALTH INSURANCE PEOPLE NOT PROFIT! FAMILY VALUES!
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