A Guide Through the Long-Term Care Insurance Maze

Last summer, Sandy’s mother was placed in an assisted living facility’s Memory Care Unit. After years of paying for a long-term care insurance policy, the time had come for her to begin collecting benefits.

Yet Sandy found that the process of accessing the long-term care benefits that had been paid for was extremely complex. And while she had been handling details of her mother’s care for some time, she knew she would need outside help dealing with the assisted living facility and the insurance company.

“I needed someone who had the expertise to be able to present herself on behalf of the family and to be on equal ground, to be able to use the same language as the doctor, the assisted living facility and the insurance company,” Sandy said. Fortunately, she found Nicole Christensen of Care Answered to help navigate the maze of paperwork.

“The LTC insurance company that my mom had spent so much money on for the past few years was giving us push back regarding the terms of coverage,” Sandy explained. “Nicole spent countless hours on the phone with me as well as with the assisted living facility and the insurance company making sure all the paperwork was correct.”

But Nicole’s help didn’t end there. “Nicole has also been the liaison with my mother’s doctors’ offices, who also have to file certain paperwork within certain time limits as per insurance company,” Sandy said. “Nicole has been on top of this process from day one. She continues to monitor all paperwork with all parties in this process.”

The impact on Sandy’s life has been immeasurable.

“Having had Nicole as our liaison now for more than a year has enabled me to be able to actually be a little calmer in regard to sharing the responsibility for paperwork and payments” Sandy said. “Nobody can fully appreciate the service that she provides until they have the need for her help, but nobody should ever even consider navigating through the system without someone like her.”

Today, Sandy wholeheartedly recommends Nicole and Care Answered to anyone dealing with a similar situation.

“I would encourage any family in any long-term care or life-changing situation to immediately contact Nicole to have her mediate for your loved one and be the advocate that you will need,” Sandy stated. “She is a wonderful listener and can put a plan into action to achieve the outcome that the family needs. Nicole is an invaluable asset every family should avail themselves of.

To learn more, give Care Answered a call at 516-584-2007.

Don’t let a chronic illness prevent you from enjoying the holidays

beansLiving with a chronic illness or as a caregiver to a loved one with a serious health issue can be stressful on a day-to-day basis. When additional activities associated with the holidays – shopping, cooking, entertaining, visiting and more – are added, it is easy to feel overwhelmed. However, careful planning and simple strategies can help you avoid exhaustion, flare-ups and stress. Here are a few tips:

  1. Plan ahead. Try to avoid last-minute parties, visits and obligations. Having a clear idea of holiday events well ahead of time can help you plan in advance. Schedule preparation time as well as rest time in order to conserve your energy so that you can be fully present.
  2. Don’t be afraid to say no. Self-awareness and self-care are essential during the busy holiday season. You know what you will be able to accomplish and how much you can handle. Give yourself permission to turn down invitations and avoid situations that will drain your energy.
  3. Remember to prioritize your health. Important routines – medication, therapy, diet, and doctors’ appointments – must be maintained, regardless of your holiday plans. Try as much as possible to maintain those schedules. In addition, be sure that caregivers are taking care of their own health. Only by remaining well can a caregiver continue to be there for their loved ones.
  4. Scale back your expectations. It’s OK to host a smaller holiday gathering, to contribute a store-bought dessert rather than a home-baked treat, or to give gift cards instead of personal gifts this holiday season. Remember that the true meaning of the holidays lies in being with friends and loved ones. Trying to live up to holidays past or your own image of the perfect celebration may not be realistic or even necessary.
  5. Do a little at a time. Whether you are addressing cards, wrapping gifts, or cooking a meal, break the task down into smaller chunks. Start early, and schedule time to rest and unwind between chores.
  6. Ask for help. How often have you heard the words, “Is there anything I can do to help?” People truly do want to lend a hand, but often they don’t know exactly what you need. Don’t hesitate to ask those around you to pitch in. If you are financially able, hire someone to help with chores such as shopping, cooking and cleaning.
  7. Take time for you. Schedule time to do things that provide you with a sense of peace and pleasure. Read a book, watch your favorite TV show, talk to a friend, meditate or just breathe. These mini-breaks will help you to recharge your batteries so that you can keep going!

Forget Politics…Talk About Healthcare Decisions this Holiday Season

Thanksgiving is right around the corner. As you get ready to roast the turkey, bake the pies and gather with loved ones, think about adding one new tradition to your family gatherings. Take politics off the table and instead use the time together to talk about healthcare. Share any important family medical history and discuss the decisions you would like made on your behalf should you become unable to make care decisions for yourself.

A good place to start is to give your loved ones peace of mind by selecting your health care proxy.

What is a Healthcare Proxy?

The New York Health Care Proxy Law allows you to appoint someone you trust — for example, a family member or close friend – to make health care decisions for you if you lose the ability to make decisions yourself. By appointing a health care agent, you can make sure that health care providers follow your wishes. Learn more here.

How do you talk about healthcare decisions?

Once you have selected your proxy, be sure to inform that person about his or her role and let him or her know about your wishes should an illness or injury leave you unable to make your own healthcare decisions.

Sometimes these topics make people uncomfortable. Try to ease the discomfort with these suggested opening lines:

“My faith is important to me and I don’t want to have….”

“I’m allergic to …. Please make sure that I don’t receive that medicine”

Talk about what you value as specifically as you can. You might say:

“I don’t want to ever be sustained by machines,” or “I have to be able to live independently,” or “There are new health findings every day. I would like to be kept alive until they find a cure.”

Points to remember about healthcare decisions

The discussion with your healthcare proxy can and should be ongoing. You cannot imagine every possible scenario but if the person you select as your healthcare proxy understands your values and knows the types of life-sustaining treatments that you would want, as well as those interventions that you would not want, your proxy will feel confident that they are following your wishes rather than having to decide your fate on their own.

This is not a contest of who loves you the most; rather, it’s about who will be able to carry out your wishes.

It is a tremendous burden to expect your loved ones to make these decisions for you if you have not expressly told them your wishes. Help them be your proxy by freely sharing your feelings.

Take time this holiday season to begin your discussion. And fill out your healthcare proxy form. Think of it as a compassionate gift to your loved ones should they ever have to make an important healthcare decision for you.

 

Do I Have to Pay This Bill?

“…in this world nothing can be said to be certain, except death and taxes.” To this list of life’s certainties attributed to Benjamin Franklin, we might also add bills. While the season of gift catalogs and holiday greetings is nearly upon us, our mailboxes are perennially filled with notices of balances due from utility companies, credit card providers, and medical offices, among many others.

When it comes to medical bills, there is often confusion about what we are responsible to pay, what should be covered by insurance, Medicare or supplemental Medicare plans, and whether other arrangements can be made.

Care Answered works with our clients before they have a medical encounter to ensure that planned services and providers will be covered by their insurance.  If you receive an unexpected bill after services are rendered by a healthcare provider, our best advice is to not automatically pay it before asking a few questions.

If you believe you received a bill for a medical encounter that should have been covered by insurance, contact your insurance provider and ask them specifically why they did not pay it. If the services provided are unclear, call the provider and ask for a detailed, itemized bill. If something listed on your bill is unclear to you, ask what it is.

Long-term skilled nursing facilities (A.K.A. nursing homes) should not bill patients who are covered by Medicaid. If your loved one has been approved for nursing home Medicaid and you receive a bill for their care, you may not be responsible to pay it.

Bills are generated by people working in billing departments; they are human and sometimes make mistakes so it always pays to check your bills carefully. If you feel you need an advocate because the billing seems wrong or if you want to make sure you don’t get charged before you go, contact Care Answered or call us at (516) 584-2007.

Untangling healthcare bills can be daunting, especially when you should be focusing on getting better.  We can help.

GuildNet MLTC Closure Update

The New York State Department of Health has affirmed that GuildNet will close as a Managed Long Term Care (MLTC) provider as of January 1, 2019. GuildNet had already ceased MLTC operations on Long Island, so this change primarily affects those in the boroughs of New York City and other parts of the state.

Current GuildNet MLTC clients need to be assessed and select a new MLTC company by December 18, 2018. Please note: if you would like to keep your current home care agency, an MLTC that has a contract with that home care agency MUST be selected.

The new MLTC is required by the state to do the following:

  • Continue to provide services under the enrollee´s existing plan of care, and utilize existing providers, for the earlier of the following: (i) one hundred twenty (120) days after enrollment; or (ii) until the new plan has conducted an assessment and the enrollee has agreed to the new plan of care.
  • Conduct an assessment within 30 days of the transfer enrollment effective date, unless a longer time frame has been expressly authorized by the Department at its sole discretion.

The new MLTC will conduct a new assessment and may recommend changes to the patient’s plan of care. Keep in mind that if you would like to change your new MLTC for any reason (for example, if they want to reduce hours of care), you MUST make that change within the first 90 days.

Click here for additional information: http://www.wnylc.com/health/news/78/

This process can be confusing and overwhelming. Contact Care Answered at 516-584-2007 with any questions or for help selecting a new MLTC agency.

Help with the Juggling Act

Michael Pacella with his youngest grandson, Ryan, his youngest great-grandson, Nolan, and daughter, Linda Wangner

Linda Wangner was in a bind, one that would be familiar to many people struggling to provide care for an elderly loved one while juggling their own lives – living far away, taking care of a spouse with a medical issue, and balancing professional and personal responsibilities.

Linda and her husband live in Arizona part of the year, and Garden City, near her 100-year-old father, the rest of the time. Her father, Michael Pacella, is able to live independently with the help of home health aides. The trouble began a few years ago when she needed to transition from one Managed Long Term Care provider to another. She spent months waiting for an intake interview, only to find that the new agency would only provide aides for eight hours a day, while Mr. Pacella needed round-the-clock care.

At the same time, Linda’s husband underwent surgery that left him immobile during his recuperation. Linda was unable to stay with her father, and unable to care for him in her home while she was on Long Island. During their time in Arizona, Linda teaches part time at the state university, serves on the board of several clubs and helps run her development’s Homeowner’s Association. As the situation in New York deteriorated, she had difficulty carrying out her normal activities due to the stress of constant telephone calls regarding issues with her father’s care. Relief aides failed to show up to take care of him. Others would leave him alone during their shifts. The police would be called, and Mr. Pacella would be taken to a hospital and then discharged to a nursing home until home care could be arranged again.

Then Linda met Nicole Christensen, a healthcare advocate and owner of Care Answered. Nicole met Mr. Pacella and the two hit it off. She was able to persuade him to visit the neurologist, and it was found that he suffered from damage to two areas of his brain that influenced his impulse control and decision making. Care Answered was then able to put in place and coordinate physical therapy at home that helped him do the things he loves.

Nicole was able to transition Mr. Pacella’s care to a new MLTC and home care providers that Linda describes as “light years better than the other agencies.”

As a result, she says, “My Dad has been calmer, easier to get along with.”

Linda has recommended Nicole to many others who are dealing with similar issues.

“Nicole got involved, and life calmed down,” she says. “I had never heard of a patient advocate before, but Nicole could be the poster child for it. She is the best in her field.”

 

 

Alcohol Abuse in the Elderly: A Growing Problem

When you imagine an individual with a drinking problem, who do you picture? Is it a troubled teen? A college student who binge drinks on the weekend? A middle-aged man who has a few cocktails to unwind after work every evening?

Alcohol abuse can affect anyone at any age, but it is an increasing problem among the elderly. And, when older adults drink to excess, they may be opening the door to a range of other health problems.

Alcohol’s effects can be more pronounced in the body as we age, so drinking the same amount may cause a person to feel more intoxicated than they expect. Alcohol can also mask other health signs and become mistaken for symptoms of other common diseases. For example, alcohol may cause a person to become forgetful or confused, which could be mistaken for dementia or Alzheimer’s disease. Alcohol abuse can cause changes in blood vessels and the heart and could dull the pain of a heart attack leading to delayed treatment.

Alcohol abuse can worsen osteoporosis, diabetes and high blood pressure, and could contribute to strokes, ulcers and mood disorders. In addition, alcohol abuse can make it more difficult for physicians to prescribe appropriate pain relief medications should the individual require surgery or have a health issue that requires pain control.

Older adults may begin or increase their drinking to help them deal with sadness and depression. These feelings, while NOT considered a normal part of aging, are common responses to loss, loneliness and illness that many elderly people face.

If you suspect that an aging loved one may be abusing alcohol, it is important to offer support and help. Try to identify the underlying issues and find ways to address them. The causes can be complex and not easy to fix, but there are a range of community-based resources that can help. For additional information, visit the National Institute on Aging, or give me a call at 516-584-2007.

How Healthcare Advocacy Can Benefit Your Employees

Our healthcare system is growing more and more complex. Medical breakthroughs create new treatment options to consider. Regulatory reforms are changing the way physicians practice, while economic factors impact on the way insurance companies pay for the services we receive. The outcomes of the choices and decisions we make can truly be life altering. These are important and complicated issues.

At the same time, healthcare costs continue to be a concern for companies and workers alike.

To help address these complicated issues, many employers have begun offering healthcare advocacy services as an employee benefit.

Healthcare advocates can save time and money for both employers and employees. They do this by:

  • Reducing stress and improving productivity for employees
  • Helping employees select lowest cost, highest quality providers and facilities
  • Providing healthcare navigation for employees and their family members, including aging relatives
  • Reviewing medical bills for accuracy
  • Answering questions that would otherwise require handling by internal human resources staff

 

Offering healthcare advocacy as an employee benefit is cost-effective. Advocacy services can be added to a benefits package for just a few dollars per employee per month.

According to a 2017 survey by consulting firm Mercer, nearly half of employers with 500 or more employees offer healthcare advocacy services as part of their benefits package. Among very large employers – those with 20,000 workers or more – 60% offer advocacy as a benefit.

The advantages are magnified for smaller employers. If even one key employee at a smaller company needs healthcare advocacy for themselves or a family member, providing the service so that the employee can focus fully on their work can mean the difference between continued success and financial devastation for a small company.

To learn more about how healthcare advocacy could benefit your workforce, contact Care Answered.

 

Telemedicine Lets You and Your Doctor Connect Without the Commute

If you’re in need of medical care, just getting out of the house can be a struggle some days. But just as technology is allowing us to connect with friends across the world in new and exciting ways every day, it’s also allowing us to connect with our care providers as well. Telehealth is the use of telecommunication technology to enhance health care in general, and telemedicine is the application of the technologies to improve the quality of health care given. Both are similar in scope, but telehealth is the overall subject name.

Telemedicine covers a wide variety of applications, so it can be used in many different situations. An example of telemedicine would be using video communications such as Skype to meet with your doctor instead of going to his or her office. Another would be if a patient uses a mobile device to take a picture of an injury and sends that to their doctor. Additionally, if two doctors use an application to send patient records between them that would also be considered telemedicine. Telemedicine has a number of different applications to help facilitate the best care possible.

Telemedicine when used properly allows practitioners and patients to connect without the commute. A patient can simply use their mobile device or personal computer to get in touch with their clinician if they have any questions, need reminders, or have a condition that they wish to have checked out but isn’t worth a trip to the office. This is especially helpful for seniors who may struggle to maintain their independence and ability to transport themselves to their care providers on their terms as they get older.

Many commercial insurance providers offer telemedicine as a covered benefit, and more and more doctors are offering some type of telemedicine services to their patients. If you would like to know more about the different ways that telemedicine can make your life easier and your healthcare more personalized, need help finding a doctor, or want to learn more about ensuring that your care is the best it can be for you, contact us at CareAnswered. We’re here to help.

Just What Does a Patient Advocate Do?

As healthcare evolves, doctor’s visits have only gotten more complicated. When was the last time you managed to finish an appointment without receiving a litany of things to remember: don’t eat this food; do eat this food; exercise more; take this medication at morning, noon, but not night: take this unpronounceable medication as needed, but this similarly spelled medicine can only be administered once per day. To make matters worse, you’re already under a lot of stress due to the health concern that brought you there today. At a certain point it becomes impossible to remember everything you are supposed to do to take care of your own health.

But what if you didn’t have to? What if you had someone who was there with you every step of the way to take notes, or bring up concerns you may have forgotten or just don’t feel comfortable voicing on your own? What if you had a patient advocate?

A patient advocate can be anyone you can trust. You can ask a family member or loved one to be your advocate or you can hire a professional patient advocate to stand by your side. Either way, your patient advocate will be with you for every step of treatment, making sure that you get the best care available. With a patient advocate by your side, you no longer need to divide your attention between your recovery and your care.

Your patient advocate will accompany you to all your appointments and take notes on what the doctor says. They’ll help you understand just what your doctor is talking about, and what you need to do to recover. Additionally, your patient advocate will speak up about any concerns you may have. Your patient advocate is your best ally and confidant in the doctor’s office.

A patient advocate can do all of this and more: help you select the best treatment option or facility for your care; help you untangle and understand your health insurance benefits and coverage; help create a safe discharge from the hospital, help you with decisions for yourself or a loved one.

If you do not have someone in mind to be your patient advocate, or simply have more questions, contact Care Answered and we will gladly help you through the process, at every step of the way.