Caregivers Story

Story

I just helped my mother, age 89, deal with her Medicare HMO. Her primary care doctor referred her to a specialist for a nerve conduction study to see if she was a candidate for carpal tunnel surgery. The office staff did not realize that they were required to get prior authorization for that procedure and the HMO denied coverage for the procedure.
My mother got a bill for over $2000. I helped her go through the grievance process to ensure she met the deadlines and used language that would help her case. I argued that the elderly do not fully understand all the fine print in their insurance contracts, and they rely on their primary care doctor to send in the proper forms and get care authorized for them. The HMO reversed its decision and paid the claim.

by: S.

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QUESTIONS

  • What are rules for Medicaid recipients with regard to the other spouses rights? I'm planning for if I would have to go to a Nursing Home.
  • if i lost my gun rights (due to going to prison) but waited 12 years after getting out and started buying guns , and then got charged with misconduct with weapons. Because i did not know i had to file something, but after my arrest i have filed and got my civil and gun rights back, but am facing a class 4 felony and 4.5 years in prison. Is this beatable in trial due to to the fact i have my rights back now, after my new arrest though. Please help ASAP
  • Can I request "in-home" assistance thru AHCCCS? We are in need of assistance for someone with mild Alheimer's as reminders for taking medicine and for personal health & safety a few hours a day. Is this possible thru AHCCCS?
  • My parents are on social security income only and we are evaluating whether to put my Dad in a nursing home. He would most likely be eligible for ALTCS. My parents own their home and it is the only asset left to support my mother. I heard that a nursing home can take half the house value if the house is sold within 3 years of my father entering a facility. Can the home be put into a trust for my mother or sold to a family member before my father enters a nursing home to avoid this?
  • I recently moved to Arizona from Oregon. I tried to be seen by a local internist and was refused service without an explanation. I have no conditions which could make me a concern. I asked the office for their evaluation criteria and they would not provide it. If they are going to refuse service, they should at least state the grounds for doing so.
  • The provider that diagnosed my son with autism is withholding records due to non payment. The law says she cannot do this. What is my next step?
  • I have an adult handicapped daughter who lives alone and has been put in hospital for emergency care several times for severely neglecting herself;refusing to eat or receive help or care from family. She is paralyzed with Spina Bifida, mentally ill, and suicidal. Presently in hospital for her neglect.I am her mother.She needs long term care but refuses/How can I do it legally?
  • Where can I get more information about Medicare and my various health care options?
  • My wife is permanatly disabled under social security disablity. Part of her disablitiy is problems with comprehension. Between her learning disablity and hearing impairment, she has a really hard time comunicating with doctors and insurance companies. She just can't comprehend these things. She wants me to be her Medical Power of Attorney so that she doesn't have to deal with insurance companies customer service. The only information I can find is related to seniors. Can you help us? Where to go.. who to see?
  • My mother had quad bypass surgery 10/07. Upon coming home from the hospital we needed a caregiver to help my mom take her meds go to the bathroom , feed herself , bathe herself etc. After 90 days my mothers LTC kicked in. We filed a claim with Humana , which is the provider that administers her medicare , on 04/20/07. We called a couple of weeks later and were told it takes 30 days to process. We then called the end of May and were told they have it but to wait another 30 days. We called at the end of June and were now told it was in the wrong dept but it would now be expedited. I called mid July spoke to a "manager " Joe Clark who said it was still in the worng dept but he wopuld expedite it and call me back in 1-2 days. NO CALL 10 days later I call and speak to Stephanie, and she tells me her sup. will call me back NO CALL. i call 5 days later speak to Woodley , he tells me he has no idea about the delay but will rush it. I call at the end of July speak to yet another manager who tells me they "changed" vendors and need me to refax the entire claim. She asks me what the claim is about I tell her and she tells me that what I described to her is really more "housekeeping" work and not covered. KEEP IN MIND she hasn't even reviewed the claim. I am now approaching 4 months since we first submitted this and I am at wits end. What are my options to get this expedited one way or another

STORIES

  • I just helped my mother, age 89, deal with her Medicare HMO. . .
  • He told me that I could actually get all the money I needed by using my home as collateral. . .
  • He told me that I could actually get all the money I needed by using my home as collateral. . .

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