Nords, what Medicare supplemental insurance and prescription insurance does your dad have?
Back in 1999 (when he turned age 65) my Dad chose Bankers Life and Casualty for his Medicare supplemental insurance. I chose not to mess with it and have just renewed it each year, but I keep flipflopping between a short-term perspective and a long-term perspective. That's the hardest part of taking care of Alzheimer's finances. That perspective switching is probably one of the hardest parts of Alzheimer's caregiving, too.
I don't have any experience with other Medicare supplemental insurance companies, and you might have better choices. The good news is that I tell billers to send their invoices to Bankers Life, and I never hear another peep from the billers. A month or so later I'll usually get an explanation of benefits from Bankers Life that so-and-so has been paid. The not-so-good news is that if the biller doesn't do it right then BL sends the check to me, not to the biller, and it comes without an EOB or a cover letter. I have to match the amount of the check to the biller's invoice and then call the biller (or BL) to figure out the problem. (It took me about six months to figure out that issue, but back then things were kinda chaotic.) My other frustration with BL is that they don't have a website where I can look up a history of Dad's claims & payments. I don't know whether other insurers do that either, but it seems awfully stupid to keep snail-mailing me reams of paper when we could do this all online. That's probably misguided HIPAA paranoia.
Bankers Life works so hard to make their marketing and communications materials simple, pleasant, and customer-friendly. I find them just this side of patronizing and condescending. When I changed my Dad's mailing address to my home, someone (I'm not able to identify the culprit) put Dad's name on the mailing list of all the local Bankers Life agents... as well as every Medicare-oriented company and geriatrics product business on the island. Three years later I'm still stomping out the smoldering embers of that junk-mail wildfire.
[rant] Side issue: what really pisses me off are the medical billers who send one invoice and then turn the account over to a collection agency. Just what the patient (or the caregiver) needs-- more threatening letters and phone calls. Luckily these miscreants are less than 5% of the billers, or maybe they don't stay in business very long. [/rant]
Dad's prescription insurance came through his Westinghouse (CBS) pension in 1999: Medco. Medco was bought out last year by Express Scripts, which seems to be the only remaining prescription-insurance company-- or at least the 800-pound gorilla. I'm also reluctant to try to shop around this benefit for a better deal.
I do not care for Express Scripts. They have difficulty understanding why an Alzheimer's patient would need more than one year of anti-depressants and why a care facility won't use Express Scripts' mail-order refill service. Both times I've had to coordinate extensive correspondence between Dad's doctor and Express Scripts to get a "waiver" to maintain the status quo. Express Scripts also has absolutely no respect for a state probate court order appointing a conservator. Luckily they were able to believe that Dad signed me up on their website as his "authorized representative" so that we could work on the aforementioned waiver paperwork. Again, this sort of HIPAA charade gets very tiresome at precisely the time that the caregiver is the most frazzled-- and Express Scripts must only go through this kabuki script about a thousand times a month. Their educational materials are way over the line into the patronizing/condescending category, complete with full-color images of stereotyped white-haired smiling elders. Their website is just as bad-- "You just signed up for our website notification service-- you're taking charge of your health! Good for you!!"
Express Scripts' website is still better than BL, but Express Scripts also continues to send threatening letters about mail-order refills. It took me a couple of frustrated phone calls to realize that their mail-order waiver is valid for at least a year, but it takes almost as long for them to shut off the auto-mailer.
The good news is that I only had to make one phone call to the pharmacy that serves Dad's care facility, and they promptly connected with Medco/Express Scripts. The pharmacy seems like a small local business with an outsourced biller service, but the monthly copay for Dad's half-dozen meds is only about $25-$40. They were also a big help in 2011 with Dad's anti-nausea meds for his chemotherapy, because each dose cost $250--
after the copay. They're pretty responsive to phone calls and e-mails.
I'm probably preaching to the choir, but here's my suggestion to anyone of Medicare age: teach your responsible adult children how to take over for you. Don't just show your spouse or a sibling/relative of your generation-- they have enough on their hands already. If you don't have responsible adult children then find a local geriatric care manager who will keep a (free) file on you and wait for the call. Ideally that change of command will never need to happen, but walk through the exercise now. (It'll also save your children from working themselves up to initiate that awkward conversation with you.) Either send them the websites/account numbers/logins/passwords, or give them the location of your file with the info, or leave a trail of breadcrumbs-- but
tell them what you've done. Don't just offer vague reassurances or hint about scavenger hunts: sit them down for a frank conversation with all the gory details. Don't lock the folder away somewhere "safe"-- make it accessible when they come to your home after visiting you in the ICU (and after traveling all night to get there, and while everyone is exhausted & worried). Take a hint from the military and pretend that the crisis is going to hit when everyone is already overworked and exhausted.
By the way, your old POA is usually worthless. Your "durable" POA is not much better than Charmin. You either need to have a fresh POA on file that you're willing to update every year (and keep in your "Emergency" folder in your file cabinet) or you need to name an alternate trustee on your revocable living trust. You might also consider opening a joint checking account with a few thousand bucks in it (and the checkbook in your Emergency folder), or gifting your progeny with that amount to use when the time comes. Between the night I got "the call" and nearly 10 months later when I got the conservator court order, I blew through $10K in legal bills and another $8K in caregiver/travel expenses. Even after the court order was signed, the fun was just beginning.
It goes without saying that you have a will in that folder, as well as a medical directive and a designated healthcare representative. And if you're a military veteran then you'd better have a copy of your freakin' DD-214 in there too.
Not that I'm bitter or anything. But you probably don't want your adult children to feel that way too.