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

  • 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
  • I have a Health Care Advance Directive from another state. Some of my friends say it is valid, others no. I suspect it is really up to the local hospital/doctor whether to honor it. Can you tell me if there is an AZ law that REQUIRES hospital/doctor to follow it? If so, can you tell me the law (statue??) that applies so I can refer to it if necessary? Thank you
  • 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.
  • 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?
  • I CANT FIND A LAWYER WHO WILL TAKE MY CASE. I AM SUFFERING FROM A HYPOXIC BRAIN INJURY AFTER BOWEL OBSTRUCTION SURGERY. IM RUNNING OUT OF TIME TO FILE. WHATEVER HAPPENED TO JUSTICE FOR ALL?
  • 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.
  • What is Medicare?
  • My 91 year-old father has recently been admitted to an Altzheimer's long term care facility. My stepsister, his ex-wife and a fiduciary have healthcare Power of Attorney. The fiduciary is private and only acts as a substitute. I have no access to his medical records. I live in CA & cannot take charge of his care. He's medicated and sleepy all the time. How can I get access to his medical records without becoming responsible for his care from another state? My stepsister is not cooperative and has even threatened my visits with my father. The fiduciary interceded on my behalf. His ex-wife has taken all his assets.
  • Do I need long-term care insurance?
  • My father-in-law just got approved for AHCCCS. He had originally signed up for Humana so wondering if he can still use the Humana?

STORIES

  • He told me that I could actually get all the money I needed by using my home as collateral. . .
  • If you get a divorce, make sure your date of birth is on the Decree if your name is changing!. . .
  • Age discrimination in the workplace. . .

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FIND LEGAL HELP

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OTHER LEGAL RESOURCES

  • State Bar of Arizona
    www.azbar.org
  • Maricopa County Bar
    www.maricopabar.org
    Referral number 602-257-4434
  • Pima County Bar
    www.pimacountybar.org
    Referral number 520-623-4625
  • National Domestic Violence Hotline
    800-799-7233
  • Bankruptcy Court Self Help Center
    866-553-0893
  • Certified Legal Document Preparer Program
    Link

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