Category Archives: Medicare

Sometimes You Just Need a Lion on Your Side…….

I called the hospital today. Well, more accurately, I called the hospital billing department. The billing department is no longer in the hospital. The hospital is in Pennsylvania, where I live, and where my loved ones go to the hospital when they have a problem, medically.

The billing department is in Tennessee, where nobody, who goes to my hospital, lives or goes to if they have a problem medically or otherwise. Okay, maybe that ‘s not true, maybe some people go to Tennessee if they have a problem with say, country music, and want to see if it’s them or the music.

By putting the ‘billing department’ in Tennessee, it prevents all of us in Pennsylvania from actually going to the billing department to talk about a problem. That way no one has to discuss these problems face-to-face. So much easier, said no one, ever.

I called Tennessee today, and although the gentlemen was very nice, the problem was apparently unsolvable.

“I want to know if this bill, which started out at $4500 and is now magically down to $500 has been paid? ” I queried, for the third time in three months.

“Well, ma’am let me see. Now before I answer that question, even though you’ve given me the account number, can you give me the address on the bill, the date of birth of the patient, the date of the bill, the services rendered, the patient’s blood type and the name of their cat?” he asked ever so politely.

Okay, he didn’t ask for the blood type or the cat, but why not? My question is, why in heaven’s name do you put an account number on the bill if it means absolutely nothing in terms of information? Do you make more money by keeping me on the phone? Are you tracing the call just to make sure I’m not in Tennessee, but that I stayed in Pennsylvania where I belong?

We do-si-do all around the information, until we’re both exhausted and wish we had taken more square-dancing lessons, and finally, he says:

“Please ignore that bill ma’am the insurance company has agreed to review it.”

“Okay, but I have an estate to settle, so can I assume that the bill will be no more than the $500 you currently are requesting?”

“No, you cannot.”

Here’s where I want to find a cat, maybe a tiger or a lion, and release it into the wilds of Tennessee with the scent of this insurance company on its nose like a barrel of catnip.

“Um……….why would that be?”

“Well, what if the insurance company decides to take back all the payments they already made? Then the bill would be more.”

“Why would they do that?” I asked, “Medicare paid this over a year ago and this has been your fault for not properly submitting the balance to the other Medigap insurance carrier.”

“Well,” he replied, “we don’t know what they will do.”

‘Cause you don’t know what you’re doing……that’s really what I wanted to say.

But since he told me to ignore the bill, I’m gonna’ do just that. Probably forever.

“You Just have to Laugh…..”

©Cathy Sikorski 2016

 

You might be a Caregiver….Part One

Just as I was sitting down to bring you the next installment of caregiving comedy, my computer decided the last laugh would be on me. Done, died, dead. With no warning, no goodbyes, no fond farewells, just dead.

These two weeks provided lots of time to come up with all the joys that caregivers experience. So in a huge nod to Jeff Foxworthy, I bring you the first installment of:

“You might be a Caregiver……”

  1. If you know Medicare’s phone number and website without Googling….You might be a Caregiver….
  2. If your search for an Assisted Living Community for your Mom starts to look like a nice vacation spot for you and your spouse….You might be a Caregiver
  3. If you cancel your dentist appointment to attend Ice Cream Social Wednesday at your Dad’s nursing home, because you want the ice cream….You might be a Caregiver
  4. If you know your parents’ Medicare number, AARP number, United Healthcare number but not your own cell phone number…You might be a Caregiver
  5. If you feel the need to correct WebMD about all the missed additional symptoms of a urinary tract infection….You might be a Caregiver
  6. If your iPhone calendar has words on it like ‘catheters’, ‘hearing aid’, ‘urologist’, or ‘dentures’…..You might be a Caregiver
  7. If going to the Emergency Room is like Cheers where they know your first name and how you take your coffee…..You might be a Caregiver
  8. If you took the black Sharpie to your husband’s underwear to mark it for the wash instead of your Mom’s for the nursing home…..You might be a Caregiver
  9. If you’ve had more knock-down, drag-out fights with Insurance Companies, Hospitals and Doctor’s office than Muhammad Ali…..You might be a Caregiver
  10. If everyone around you thinks you are speaking in tongues because you are constantly saying, PT, OT, UTI, or DME….You might be a Caregiver

And this is only the beginning, my friends. After all, this is a new computer, so there’s lots of room for humor here now!

“You Just have to Laugh……”

©Cathy Sikorski 2016

You talkin’ to me?

So these stories about medical insurance could go on endlessly, but they give me such good material.

My Mom called me a few days ago to tell me that she received eighteen EOBs (Explanation

What do you mean you're not Zsa Zsa?
What do you mean you’re not Zsa Zsa?

of Benefits forms) from her medical insurance. If you’re not an EOB counter, 18 is a Zsa Zsa galore. A normal amount might be 2 or 3 on a busy day.

The reason she received 18 is because of the huge mix up created by her medical insurance 15 years ago. Fifteen years is a lot too–a whole teenage year of angst. Now, there are two insurance companies trying to figure out how to pay each other back for 15 years of screwing up.

Half of the EOBs indicate that Insurance Company B paid claims formerly paid by  Company A, and everyone is happy about that.

The other half of the envelopes  were filled with EOB’s and checks. Lots and lots of checks. All these checks are payable to my Mom for claims going back to 2007.  Insurance Company B has paid all that money that is supposed to go to various medical providers to my Mom.

So somehow my 87-year-old Mom is supposed to divvy up these checks, figure out who needs to be paid and how much and hope that the medical providers can properly credit her account, some going back 9 years. Really?

I got on the phone.

I have come to love you so much, my dear readers, that you won’t get every bit of every one of the 4 hour-long conversations I had with Insurance Companies A and B.  You know some of this is priceless.

“Hello, my name is John, thank you for calling Insurance Company B, how can I help you?”

“Hi, John, my name is Cathy, I’m calling for my Mom, who is sitting right here with me.”

I hand the phone to my Mom because I know that John needs to interrogate her. She also needs to give John permission to speak to me. After they complete that happy dance, Mom hands the phone back to me.

John asks me for my address.

“No, John, you can’t have my address. You can have my mother’s address, as she is your insured. I have called your insurance company thousands of times and no one has ever asked me for my address.”

“Oh,” said John, “I have to speak to my supervisor.” I’m pretty sure this is John’s first day of work.

He comes back five minutes later and tells me he can’t talk to me if I won’t give him my address. I am undaunted.

I hand the phone to my Mom. He asks for her address, birthdate and phone number. My Mom tells him everything he requests. Then she says,

“Now I want you to talk to my daughter because I have no idea how to deal with any of this.”

She hands me the phone. John and I have a long conversation about how to deal with this complicated problem. John cavalierly tells me that this happens less than one percent of the time. How he knows this from one day on the job, I have no idea. It is, however,  supposed to reassure me.

“John, just stop sending checks to my Mom.”

“I have no idea why that happened. They should be going directly to the provider. I have 458 claims here to be processed for your Mom over the last 10 years. But we could just start over. We could reclaim those checks and redo those claims. I don’t know……”

“NOOOOO, John, DO NOT DO THAT!” Yes, I meant to use capital letters, because it was a capital letter kind of response.

“But……,” said John…..”we……”

“No, John, just NO. Do not add insult to injury. Just stop doing what you’re doing.”

“Is there anything else, I can help you with , ma’am?”

“No, John.” I so wanted to say….”But you did talk to me without ever getting my address, didn’t you? ”

I win!

We all know I haven’t won…but

“You Just have to Laugh…..”

©2016 Cathy Sikorski

 

 

Frost and a Sweat………..

Two roads diverged in a yellow wood and I took both of them…

I was sitting around in my workout clothes, pretending to think about going to the gym. But I thought a tougher work out would really build my stamina.

I decided to try and tackle Medicare and the VA on the same day.  See tackling is a form of exercise.

First stop, the VA. Truthfully, after examining my own guns, I knew it was time to call in the big guns and went right to my U.S. Representative in Congress to get help. I was done pussy-footing around. I called my Rep’s local office and was met with immediate efficiency and comprehension.

Like an innocent child, who has a learning curve the size of the Earth’s parabola (I don’t even know if that’s a ‘thing’ but it sounded really big to me) I believed that help was on the way quickly, and all my problems would be solved post-haste. And by using Ye Olde English terms like ‘post-haste,’ I would surely be drinking celebratory sherry in the drawing room at the end of the day!

But before these kind people could step in, they asked me to call the local VA office. See, the Rep had friends in high places. He is actually on the Congressional committee that deals with the VA. I was instructed to call the VA office in town, speak to the director there and immediately call back the Congressional Aide to let her know the result.  This was the result.

“Oh, dear, I’m so sorry your mother is having a problem with her medical insurance. That’s terrible,” said the kind woman who answered the VA phone. “I will have the director call you as soon as he is available.”

I must admit, not 10 minutes later, the kind woman who answered the phone called back.

“The ( cowardly, okay she didn’t say that but the tremor in her voice said it all)director says he wouldn’t know where to begin to help you. This problem is too complicated and he’s never seen it before. So you need to call your Congressman right back to help you.”

This from the director of the local Veteran’s Administration Office. My workout was quickly becoming the use of one finger……the dialing finger. Why, which finger were you thinking?

Meanwhile back at the ranch, thinking it would take a while for the VA to return my call, I hopped on another line (hopping is also exercise) and landed on infinite ‘hold’ for Medicare.

After following their instructions three weeks ago by filing Executor papers at the Social Security Office, and calling each week to see if they ‘received’ the papers that were scanned into the computer right before my eyes, I am now told that I must follow a completely different procedure before they will talk to me about unpaid medical claims for my deceased brother-in-law.

By the way, not one person I spoke to at Medicare or Social Security both on the phone and in person….and there were dozens of these people………..actually knows what an Executor is or does. So that was fun to explain. Explaining can cause sweating and does require mental exercise.

There were more phone calls and more paperwork created as you can see:

Medicare Papers

Two roads diverged in a yellow wood (yellow..for cowards?)

….and I took both the difficult ones….. ’cause, you know, that’s where all the fun and cardio begins!

“You Just Have to  Laugh………….”

©2016 Cathy Sikorski

Don’t Worry…..We Will Take Care of You……

Last Friday my Mom called me, practically in tears.

“Roberta was so mean to me,” she said.

I’m thinking, “who the hell is Roberta?”.

“She’s from my medical insurance carrier. I called to ask her why a bill wasn’t paid and she said I should never have been given this insurance and I’m going to have to pay back every penny from the last 15 years.”

“And,” she went on with a worried tone, “you told me to NEVER pay a medical bill. So I don’t know what to do.”

“Calm down, Mom. We will get this worked out. It will be okay.”

My first reaction was this:

I did tell my Mom never t pay a medical bill because her insurance covers everything.

My mom has Tricare For Life Medical Insurance. This insurance is for Veterans and their families, spouses, widows, children. My Dad died in a helicopter crash as an Army pilot on October 10, 1961. My mother had five children all under the age of 10 and was pregnant with her sixth child. So I kind of think my Mom is entitled to this insurance.

The thing is, Mom never claimed this insurance until my step-father passed away in 1998. She didn’t even ask for it. She already had Medicare and AARP. But when she applied for her widows benefits after my step-father passed away, the Veteran’s Administration made her jump through all kinds of hoops with documentation and then gave her this insurance.

My mom is a Virgo.

Why does that matter? She has kept every single piece of paper that has ever come into her life. So she has every piece of documentation that transpired fifteen years ago with the Veteran’s Administration. She sent them her marriage certificate to my step-father and his death certificate.

Then, they put her on the wrong insurance.

And now they are threatening an 87 year-old widow, who raised her family of six children without a father, who never even made it to 30 years old.

After talking to seven different people at seven different government administrative places which most people never even heard of, we refiled all the documentation from 15 years ago.

Now we wait.

I know from the last 25 years of caregiving and jumping through administrative hoops that this story will not have an easy ending. There’s going to be reams of paperwork. There will likely be boatloads of nastiness. There may be a lawsuit. But in my best, Scarlett O’Hara voice: “As God is my witness….my mother will never pay one dime to fix this problem.”

It helps that I’m a lawyer.

I know you don’t think there could possibly be a laugh in here in any way. But as I was looking at some of the documents from her insurance company, I saw this:

Fun things to do while fighting with Insurance
Fun things to do while fighting with Insurance

Really?

Hmmmm…..

“You Just have to Laugh…..”

©2016 Cathy Sikorski

Who you gonna’ call…Dustbusters…….

So the saga for my brother-in-law continues. Of course it does, I’m a caregiver.

He had surgery yesterday. Finally, after 12 weeks in rehab of staying in bed with a shop vac on his behind to suck the wound into a better place. I don’t know, that’s what they tell me. It’s actually called a wound vac…but it’s a mini shop vac that stays on the wound 24 hours a day to help the healing process.

My Mom, a nurse from the ’40’s says all they really had to do was keep that wound clean and dry and open to the elements. That’s what Rosie the Riveter nurses used to do and it worked fine. Of course, because his wound is on his bottom he would have had to be lying on his stomach for 12 weeks, with his derriere on display for the world to see. So I’ll take the shop vac method. Plus, if he takes home the vac, maybe it can double as a Dustbuster.

Surgery is a resounding success. The only downside is he cannot be in a sitting position for 4 to 6 weeks. I know. Maybe solitary confinement and water-boarding would be more pleasant. But what are you going to do? The problem with these damn bed sores is that they don’t heal if you don’t stay off of them. And ironically, as bed sores, you can’t stay off of them easily if you are, well, in bed, which is where they insist he stay.

So, now the protocol is that he must be lying on his side or flat on his back at all times.

My brother-in-law is an engineer. He’s actually a rocket scientist as he worked in that industry.

His first question is:

“How do I eat?”

This drives me crazy.

Not only is it not rocket science and he is a rocket scientist, he can’t figure out how he’s going to eat.

By the way, his engineering brain wants to kill me every time I have to do something with his wheelchair or tray table and I can’t figure out the best engineering way to handle it. I’m actually on his side, when he yells at me. I am NOT an engineer. I have no spatial skills whatsoever. I can’t play pool because I don’t get it. Physics eludes me. So when he is trying to explain to me how to turn the tray table around the OTHER WAY so that the feet don’t bump into his cath bag, and I just keep shoving…well he wins the frustration game that day.

MilkshakeBack and forth we go the caregiver and the caregivee with our remarkable skill sets and loss of patience for each other’s nincompoopery (I’m absolutely positive that’s a word in the caregiving lexicon).

So when he can’t figure out that he will have to lie on his side and chew and swallow the best he can, and have as many milkshakes as nature will allow to keep his calories up, and that we won’t starve him. He will have help like he’s always had these last years, well I want to …………..say a prayer of thanks that I can help. (Not really but I wanted to look better than the jerk I am in this moment).

“You Just have to Laugh…..”

©2015 Cathy Sikorski

Kelly, Kelly, Kelly, Kelly…….

I have been trying for 3 weeks to get physical therapy for my brother-in-law. He is in rehab but has to stay in bed for healing purposes. My argument is that there’s no reason he can’t be doing upper body strength training and exercise to keep those muscles from getting weak.

I asked five different people and everyone was going to “get back to me.”

This is what happened when I was in the rehab center and  they actually did:

Nurse 1: “Gee I don’t know about therapy ,let me go check. I’ll come back and tell you.”

Nurse 2: “Well, we are nursing. You will have to talk to Physical Therapy. Go downstairs to the Physical Therapy room and ask for Kelly, she is the Director.

So downstairs I go. In the  Physical Therapy conference room are 5 people. They all have name badges. I talk to the one wearing the name badge ,”Kelly.”

Kelly 1: ” Well, let me look at the register. ”

She doodles around on the computer for a few minutes.

Kelly 1:”Hmmm.I thought I could tell you why your brother-in-law is not getting therapy, but I have no idea. I’m going to have to talk to my supervisor.”

Me: “Okay. I’m going back upstairs, you can get me there. By the way, who are we waiting to talk to?”

Kelly 1: “Kelly.”

Me:(very slowly and deliberately,so I get this right)”But…. aren’t…. you……. Kelly?”

Kelly 1: “Oh there are three Kellys.”

Great. Back to my brother-in-law’s room I go. I am greeted there by Nurse 2.

Nurse 2: “I found out that your brother-in-law doesn’t qualify for therapy.”

Now this is where they expect me to say, “oh,okay.” I don’t do that…… not ever, never. I say things like:

Me: “Why?”

Nurse 2: “I have no idea, I’m nursing.”

With that dandy tidbit, in comes the Social Worker, Courtney, one of the first five people I asked about physical therapy.

Courtney 1:  “We just had a meeting with Kelly(presumably Kelly2) and she said he doesn’t qualify for therapy.”

Me: “Crazy question here….why?”

Courtney 1: “Well because his surgeon said he can’t get out of bed into a chair yet.”

Me: “I know, I talked to the surgeon’s office and they don’t know why you translated that into, ‘he should turn into a useless vegetable with no muscle mass until his wound heals.’ Which is why I had the surgeon’s office call you to say he could have physical therapy of his upper body in his bed.”

SpicyNurse 2: “Oh yes. They did call me. That girl on the phone was rather ‘spicy’ demanding that he get physical therapy and that they never said he couldn’t have it.”

Spicy? Really, a doctor’s office wants their patient to get some appropriate care and that’s spicy????

With that I look at Nurse 2, she looks at Courtney 1, and well, there we are, in a spicy conundrum.

Me: “Get him therapy, now. I don’t care how many Kellys it takes.” Wondering if that was spicy enough to get something done.

That was yesterday…..waiting for a spicy response any minute now.

“You Just  have to Laugh…..”

©2015 Cathy Sikorski

 

 

 

Another One Rides The Bus…..

For some reason, my friend, Lisa likes to be featured in this blog. So here we go.

For medical reasons, a traumatic brain injury, Lisa had  to give up her driver’s license several years ago. Eventually, she became quite savvy and capable of taking public transportation. In her small town, that means the bus. A perk, if you would like to call it that, of being on Medicare, is that you get to ride the bus for free. Otherwise it costs a dollar.

Lisa has been riding this bus for a few years now. Until recently, all she had to do was to show her Medicare card to the bus driver, and she was allowed to take a seat, gratis.

Apparently, there’s a new sheriff in town.

A few weeks ago she had this encounter with a female bus driver, whom she never saw before.

“Sorry, ma’am, but you need a special card to ride the bus as a Medicare rider.”

“No,” said Lisa, “I don’t. I have been just showing my Medicare card for years and that is sufficient.”

“No, you need the special card,” said the bus driver.

“Since when?”

“I don’t know. I just know  you need it.”

“I’ve never even seen ‘the special card’, “said Lisa.

“Well, I’ll let you go this time, but you need to get it.”

Lisa never saw that bus driver again. Since she didn’t know where to get the special card, she just let it pass.

The other day, as she was getting on the bus, there was a new young male bus driver, whom Lisa had never seen before. He’s holding a pamphlet in his hand as she ascends the stairs.

“How old are  you?”

Lisa, thinking he is complimenting her……as every middle-aged woman thinks when handing a Medicare card as ID, replies a bit quietly so as not to alarm fellow passengers who most likely think she is quite young:

“I’m 63.”

“Well, you’re barely that, I can see.”

Lisa is flattered,until he drops his bombshell.

“You can’t ride the bus for free. You have to be 65 years old.”

“I’m disabled and I’ve been doing it for years.”

dollar“Nope. Not allowed. Here’s the brochure. It’s a dollar.”

I’m happy to say here that my friend Lisa has come a long way since that TBI. Not only does she get around on her own. But after many years of trepidation just being out in the world, well, she doesn’t take crap anymore. Yay, Lisa!

“What’s  your name?”She demanded from this arrogant brute, who was so willingly ready to accost the disabled and the elderly.

“Well,ma’am,” he sheepishly replied, “if you don’t have the dollar today, you can pay next time.”

This bus driver was on a mission to save that bus company a dollar, or take a power trip every stop along the way, or who knows what, maybe her bus driver was Donald Trump in disguise and he was testing some of his new economic policies to see how to save government funds.

Never did give her his name…and…..weirdly, she hasn’t seen that bus driver again, either.

For a dollar…..did I say that already?…………..a dollar.

“You Just have to Laugh…..”

©2015 Cathy Sikorski

 

Send in the Clowns…..Don’t Bother, They’re Here

I’m thinking about asking the wheelchair repair guy if he wants to do a comedy act together.

Before I left the country for 2 weeks, I called the wheelchair repair guy (let’s call him Mike, well, because that’s his name).

“Mike,” I said, “the wheel on my brother-in-law’s chair is torn to shreds. It makes the chair bump around like he’s driving the post-Apocalyptic pothole roads from the Winter of 2015. And he’s inside….on carpet. Please get it fixed ASAP.”

“Okay,” said Mike.

The problem here is, I believed him. I knew it would be fixed, eventually.  I just hoped that with a two week lead and a few well placed reminders by my assistant, it might be close to being done when I returned.

Mike obviously spent the time shopping for a big red nose.

When I noticed my brother-in-law bumping down the hallway on my return. I sighed that exasperated sigh that we all save for just such an occasion. My exasperated assistant let me know that she even contacted Mike with the very complicated schedule of when the chair was in use or my brother-in-law was resting in bed. This was due to the fact that Mike reminded her, no one can be in the wheelchair when it is being repaired. There was even a nice little 4 day period where BIL was in the hospital, so no one was using the chair. My assistant gave that little nugget to Mike as a bonus, if he wanted to send his guy over there at ANY time of the day or night.

I called 15, 16, 18, 19 and 21 days after my first call to find out why oh why, Magic Mike can you not get your sh*&%t together and get this chair repaired? Are you practicing your own comedy routine? Are you shaping up your abs for your next film role? What is so damn important that it takes 21 days to get someone out to fix this one little wheel?

“Hello, Cathy?”

“Hi, MIke, is the chair finally fixed? You said someone would do it on Monday or Tuesday and now it is Wednesday.”

Faster than Mike. Smarter too.
Faster than Mike. Smarter too.

“Oh, no, someone has to look at the chair first, determine what parts are needed, get insurance company approval, and then physician approval.”

We’ve gone from a comedy routine to a cartoon, as steam is now exploding out both my ears.

“So all those times you said you couldn’t come because he couldn’t be in the chair, was so that you could just look at it? Let me ask you something. Couldn’t someone just look at  the chair even if he is in it?”

“Well, I guess so. But you said he was in the hospital.” How this even makes sense, I don’t know. But I’m pretty sure “Who is on first.”

“Mike, we don’t let the chair go to the hospital with my brother-in-law. The chair has proven it doesn’t know how to behave itself in public places, so when he goes to the hospital we make the chair stay home, by itself. That’s why every time he goes to the hospital, we call you to let you know no one will be in the chair for days.”

“Oh. Well, we looked at it so it will get repaired when all the approvals come in.”

Twenty-one days to look at it. I wonder if I can start sexting pictures of the wheelchair in compromising positions when I need it repaired in the future, so that Mike can definitely say they looked at it?

“You Just have to Laugh………..”

© Cathy Sikorski 2015

 

It’s Here…..It’s Here…..!!!!

showing_w_nana (1)

My baby has been launched!!!

You can find us at Amazon .com at this link:

https://www.amazon.com/author/cathysikorski

I  am so excited to see this fun work of such a long time finally come out to be a friend at your reading table. Thanks for all your continued support. Love to all of you my wonderful readers!