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Small miracles

October 25th, 2015 at 06:11 pm

Last summer I appealed a Medicare denial of a bill my mother incurred when she called 911 because she was constipated. This was part of the chain of events that led to me moving her to an assisted living community.

The bill was for the ambulance ride to the hospital, and Medicare denied it because constipation is not a good reason to call 911. So the ambulance company sent me a bill for $665.

In my appeal I showed doctor's notes and diagnoses showing my mother has dementia, and that this was the reason for the ambulance ride, not constipation.

Technically, they were probably correct. I called the ambulance company twice to make sure the bill wouldn't become delinquent while I waited to hear from Medicare. I explained I had appealed it and when i called Medicare to inquire as to status, they said you have to wait 60 days to call and then we can investigate for you.

When I called Medicare back last week, I was so surprised when they told me the bill was fully paid because the ambulance company resubmitted the bill with a revised code.

I have no idea if any of my conversations with EMS caused that to happen or not, but i am eternally grateful. It just seemed like such an enormous amount of money to waste.

The other small miracle happened today. It occurred to me that given my mother's deteriorated mental state and since I know she'll need help bathing, that she really could use a shower seat. Just another expense, I figured. I was driving home today and turned in on my street. My neighbor on the corner had a tag sale the day before and they had a "Free" sign out for the leftovers. I drove by and suddenly noticed a shower seat sitting in the grass, exactly what I wanted! I backed up, got out and picked it up. It seems fine, and it's adjustable!

I just checked Walmart and they're selling them for $52! Wow. That one really dropped in my lap from above.

My mother did not sleep again last night... at all. And it was just awful trying to get her up this morning at noon becus then she was sleepy. The aide is very good and i like her a lot but she's only available for a few days.

I am anticipating the agency tomorrow will tell me I have to pay for 2 people working 12-hour shifts so they are not exhausted by my mother. Right now I'm paying $195 a day on weekdays but with 12-hour shifts paying by the hour I'll be paying $552 a day. It's even higher on weekends and major holidays. So we're talking well over $16,000 a month. The Masonicare rent is another $5350 a month for a grand total of $22,910 a month in costs! That gives me 10 months before the money runs out. There's no doubt I need to start the Title 19 paperwork this weekend.

I got the Medicare statements for all the expenses associated with my mother's surgery. The out of pocket I'll have to pay is only $552, which I don't consider too bad.

If my mother's sleep patterns improved, I could possibly go back to the live-in aide at the lower daily rate, or if her strength and walking improved, I could possibly not have a live-in aide at all. But by the time either of those 2 scenarios happens, I'll have run out of money anyway. It's just an impossible situation. It makes me angry to squander $238,000 in this way but that's health care in America for you.

4 Responses to “Small miracles”

  1. Livingalmostlarge Says:

    What you wrote is the reality of why people argue about "paying" for their own healthcare with HDHP and being responsible for themselves. Until they've faced the situation you're in or a similar one for cancer or other long term medical care (ie MS, Parkinsons, etc) they have no idea. It's always everyone else sick, I don't use medical care. The truth is that no one thinks about how much they use medical care until they need it.

    I believe your calculations are correct for the costs. My mom is saving for exactly this reason. My grandmother is on medicaid and medicare, but even with those things they don't pay for adult care during the day. Since she lives with one of my aunts, and they still work they cannot leave her home alone. She will likely burn the house down. So all four children pay for extra care out of pocket to go to a day program. Medicaid and medicare won't cover it. Thankfully they can afford to pay 25% each but at 75/day for around 20 days a month it's $1500. Lucky with medicare they aren't paying for too much medical extras.

    This has been an ongoing payment for 3 years since she moved in right after I had my second child and my mom came to visit me and my grandmother couldn't live alone in another city than my aunts. She's a very healthy 87 and I'm not sure what the future holds. She has old age dementia. She often asks my husband "oh do you like hawaii? Have you been here often? Will you come back again?" He says "I love it." He's been visiting with me since 2000 and he just nods. She understands the children are mine, but it is painful to see the deterioration.

    So I hope you can work on the paperwork. Get help if you need. You have to have no more than $2k in cash and spend down all SS monthly when you go on medicaid. Anyway it's just a suggestion.

  2. AnotherReader Says:

    How much does it cost to move her into the nursing home side of Masonicare? If it's less, that's what I would consider at this point. I may have missed this - does she stay at Masonicare when Medicaid kicks in?

  3. PatientSaver Says:

    AnotherReader, skilled nursing facilities, as they are called, cost even more than assisted living because it's staffed by nurses and aides. Assisted living is a lower level of care because it's assumed the residents won't need as much hands-on care. That's why they told me if i was to have her in assisted living she would need an aide. i don't have the daily rate for Masonicare nursing home with me but yet it is more.

    When i run out of money she would have to be moved to the nursing home.

    Livingalmostlarge, it is very helpful when all the kids chip in, if they can afford to do so. The only alternative I see, aside from saving oodles of money which i think for the vast number of Americans is not gonna happen, is to take out a long-term care policy. But they're not cheap either. I vaguely remember my friend at work saying the premiums were $2,000 a year maybe?

    It's really something you have to plan for, just like retirement. But so many are totally not up to the challenge of saving for retirement, let alone long-term care insurance.

  4. FrugalTexan75 Says:

    Those are some good blessings!

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