In the process of caregiving, one thing that simply can’t be overlooked is dealing with insurance companies. It’s a hideous part of the role one must play. The hoops one must jump through, the forms one must fill out, the phone calls and aggravation of dealing with entities whose prime directive is to deny first, ask questions later, is daunting, exhausting and just plain evil.
I give thanks to my father regularly for having had the foresight to buy a long term care policy for himself and Mom while they were still healthy enough to qualify. In addition, Dad left assets that help me bridge the gap when the insurance companies play their games and stop the flow of payments for whatever inane reason they concoct. But I fight for what’s ours and succeed to whatever degree I can. I seem to be losing ground however, because the cards are stacked in favor of these well-financed, labyrinthine bureaucracies, supported in part by our legislators who enable these scumbags to operate in this deplorable fashion.
My mother has Genworth Financial, the leading player in the long term care insurance marketplace. Truth be told, no insurers want this piece of business any longer. It’s a loser. On a long enough time-line, odds are every insured party will become sick and will require some long term care. Ironically, my father utilized almost none of his benefits, although I did open a claim and it was deemed valid. The trajectory of his illness was so quick in terms of his policy, he died before the “elimination period” for care in a facility had concluded, so we got hung paying all of his expenses at assisted living, including medication delivery, which we ordered the night before he died. The facility, Sunrise Assisted Living in Fairfield, NJ, took our money for the drugs and the service which were NEVER USED and refused to refund them after Dad passed away in July of 2004.
I opened Mom’s claim when she started hallucinating in December of 2010. Knowing how Genworth works, I knew that the best way to proceed was to hire in-home caregivers. They prefer you start this way. It’s cheaper and satisfies the “elimination period.” After 100 days of in-home care, they will, if you jump through all the right hoops and can demonstrate that your loved one is truly in need of assistance with 3 out of 5 activities of daily living, will pay up to $125 per day for assisted living. So while AL facilities charge monthly, Genworth will pay $125 per day, so your monthly reimbursements will vary depending on how many days there are in a given month. That’s IF they agree there’s a need and the facility you choose adequately fills the prescribed “plan of care.”
Well, Mom definitely had needs which have been documented by a number of professionals and institutions. But with each new need and change of venue, I must document each one, every facility and it’s appropriateness for Mom’s care, whether Genworth is asked to pay for it or not. When medically necessary, as with Mom’s UTI and her falls, she has had to go to hospitals and rehab facilities. Those visits are paid for in part by her medical insurance (with varying co-pays borne by yours truly). Mom has AARP Secure Horizons Medicare from United Healthcare (which is actually an Oxford HMO).
The way this insurance works is, United Healthcare gets paid by Social Security for Mom’s Medicare policy. They then administer her benefits. They don’t charge anything extra for the insurance, but they force you to use their network of providers, which is pretty extensive. Unfortunately, they’re another ridiculous bureaucracy. When Mom fell down the stairs, she was taken to Valley Hospital’s Emergency Room and then admitted. They denied her claim for the hospital stay ostensibly because the results of her initial tests were negative (no broken bones). The fact that she has a heart condition, was in screaming pain and couldn’t walk on her injured leg, and that her doctor wanted to run extensive tests to rule out significant underlying illnesses as having contributed to her fall were not good enough reasons to admit her, at least not upon first submission. But they did approve physical therapy. Mom’s doctor and advocates at the hospital will contest the denial and hopefully, no outrageous bills will come my way. We’ll see. Nothing for me to do in this case but move forward and get Mom the treatment she needs right now.
Another thing I should mention to children of aging parents: go to a lawyer and get all of their documentation squared away. Be designated your parents’ Power of Attorney and Health Care Proxy so you can speak for and defend them when they can’t. You should also get a Living Will (Advance Directive) which says how they want to be dealt with as regards resuscitation, intubation and other potentially nasty life-prolonging procedures. And make sure you get advice on a Last Will and Testament so the survivors retain the maximum of the estate.
Meanwhile, Genworth has proven themselves to be in “hold up claims” mode. Two and a half months ago, they realized that Mom had moved from one home in the Potomac system (which had passed all of their criteria for appropriate care at the end of last summer’s jump-through-hoop-fest) to another home in exactly the same system, with exactly the same qualifications and care provisions, back in October (this was due to the freak snow storm that knocked out the power in her facility). But they obviously saw an opportunity to stop paying and took it.
I was confronted with two different “benefits analysts” who told me I didn’t have to do anything but wait. They chased down documentation on the facilities she’d been to LAST SUMMER which had long been paid and had not been submitted to them for payment. I had reported the chain of care to a previous benefit analyst so they would have a complete record of Mom’s travels. Now they were using it as a further delay tactic. When I found this out, I called them on it and told them to drop the investigation, that these facilities had already been paid and had nothing to do with Mom’s current care provision at Potomac at Ransey.
Finally, after calling Genworth a number of times, I learned the final obstacle was a “facility statement” that was pending from Potomac. I called Potomac, found out who was filling out the form and got confirmation of its submission.
Then I called Genworth and was promised a call-back from Jessica, the current benefit analyst within 24 hours. The next day, I got the call and confirmation that all documentation had at last been received. When would I see the money?
An “off-cycle payment” could be requested “if you want.” Yes, I want! But she could only release one payment at a time. I would get June’s payment next week, and on the 15th of August, I would get the JULY payment only. What about August?
Well, they needed to wait for the entire month to elapse before they could pay me for August, to make sure Mom got her care from them. WHAT?
All of the preceding several months, I got charged for Mom’s rent to be paid by the first of the month IN ADVANCE. Is there anyone in the world who isn’t charged on the first of the month for the month they will occupy a place of residence?
I had gotten into the habit of faxing in the invoice to Genworth when it would come in, usually a couple of weeks before it was due. So I received the August bill, due August 1st, around July 15th. I would fax it to Genworth, pay the bill on August 1 and receive reimbursement on August 15th. NOW they are telling me that going forward, I will have to wait for September 15th to be reimbursed for August.
Wow, what a racket! They get to hold on to MY MONEY for an extra month, collecting whatever interest they can on that money while I burn through my father’s assets paying for all of Mom’s other expenses, which include prescription drugs (over $200 per month, and she’s hit the donut hole by now; can’t wait to see THAT bill), hair care, sundries and various co-pays (including $50 a day for her physical therapy which Oxford will only deliver at one of their network facilities). Oh yeah, and did I mention that Mom’s rent at Potomac went up $250 a month for this year, all of which I must absorb? And continue to pay whether she stays there or not?
Add to that, the banks pay NOTHING to consumers in interest. Every time I see an offer for “high interest” of UNDER 1% on a savings account, I want to scream. Meanwhile, credit costs consumers 3, 4, 5% or more for mortgages, and in excess of 15% for credit cards, even more for department store credit interest. Why is this permitted?
Then there are other investment instruments. I can’t even bear to look at these. Junk bonds. ADPs. I’m grateful for the annuity I bought for Mom that earns 4%. Makes me feel like a freakin’ genius. When I think about how my Dad used to live off the interest from his investments back in the 90’s, I can’t believe what’s happened. The system is stacked so high against the middle class, it’s positively frightening.
Oh, but don’t tax the wealthy job creators! Explain me this: if the Bush tax cuts encouraged so much job growth, where the hell is it? You’re telling me that if people who earn $250,000 get their tax burden reinstated, they’ll stop creating new jobs? Dude, that ship has sailed to China a long, long time ago.
But I digress.
To the insurance companies upon whom we must depend: please understand that we are people, just like the ones in your own families. The next time you deny a claim for someone like my mother, imagine for a moment, that it’s YOUR mother. How would YOU feel? How would SHE feel if she were faced with fighting this without a healthy advocate?
Folks, it’s time to get big picture. Our system is seriously broken and it must be fixed, or those of us who remain WILL revolt, will rise up and will reclaim control. It’s just a matter of time. And numbers. I am the majority demographic in this country, and I will take advantage of every opportunity afforded me by sheer numbers. Be warned. I will not take this without fighting back.
And you will pay for my long term care should I get sick, Genworth. My husband and I have a policy, and I will not allow it to lapse and I will get every penny owed us should either of us ever need long term care. You are preparing me well for my future. I’m hip to your tricks and I will be ready for you.