When the Caregiver Needs Care, You Need an Advocate

 

 

Rick Pantuliano lives with his wife and two daughters just a short drive away from his parents’ Nassau County home. This proximity has allowed them to maintain a close relationship with his 77-year-old mother. Yet even though he is nearby, he still needed professional help when his mother’s dementia became significant enough that she required round-the-clock care.

“It got to a point where my mom needed to go on Medicaid,” Rick said. “Applying was a confusing process. I was pulling my hair out.”

His attorney recommended that he contact Nicole Christensen of Care Answered.

“She held my hand through the entire process,” he recalled. “She helped me understand every step of a very time consuming and complicated situation.”

Describing his mom, Raffaela, as a strong woman who was traditionally the caregiver for other family members, Rick related how she began to show signs of dementia about six years ago, six years after his father passed away from emphysema.

“She took care of her sick aunt, who died of cancer. Then she cared for her uncle who passed away of old age. She took care of her own mom and dad who lived with them for years. She took care of a lot of people,” Rick said. “Now it’s her turn, and there’s nobody there but me.”

Commuting from Long Island each day to his job in New Jersey keeps him away for long hours, adding to the stress of trying to ensure that his mom’s needs were being met. Nicole’s assistance helped Rick feel confident that he was arranging for the most appropriate care possible for his mom.

“I would still be at the starting line if it wasn’t for Nicole,” he noted. “She was my advocate. She walked me through the entire process and stepped in whenever I felt I was hitting a brick wall. She translated everything and made it understandable and easy.”

More importantly, Nicole’s intervention will ultimately save the family a significant amount of money. With her help, Rick was able to access funding to pay for live-in aides for his mom – services for which he had been paying out of pocket each month.

Rick worked with Nicole for about five months. She brought him to a point where he has a much better understanding of how the system works and feels empowered to handle the hurdles he faces. She reassured him recently by saying, “You got this,” when he was confronted with yet another form to fill out.

And he agrees. “I am basically comfortable with everything at this point,” he said.

His mom is living safely at home with 24-hour aides. Rick is thankful for the ongoing support of his wife and daughters, and for Nicole’s intervention when he needed her expertise most.

“I would highly recommend Nicole to anybody,” he said. “Unless you’re home 24 hours a day and don’t have a job and understand the ins and outs of the healthcare system, you absolutely need an advocate. Nicole is a wonderful person. She is very caring, very in tune to your needs, and she just does her job very, very well.”

 

 

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.