The Money Mustache Community
Learning, Sharing, and Teaching => Ask a Mustachian => Topic started by: Ladychips on June 18, 2016, 08:43:11 AM
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A few months ago my mom was diagnosed with renal failure. She is now on home dialysis.
She's 70something and has Medicare. She lives on a small social security check and very small pension check. Her pension check basically pays for her medicare supplement. She has no assets other than a vehicle and a small amount of money in the bank. She lives simply and does fine.
When she first began her dialysis, her doctor and his staff told her it would be fine - medicare and her supplement would cover the costs of treatment. She told me yesterday that she now has huge medical bills (I don't know what 'huge' means). They are calling her repeatedly about when she is going to pay them. She absolutely does not have the money to pay them. Well, she could probably pay what she owes now, but then she would a) not have ANY money in the bank and b) can't pay them long term. My mom abhors debt so she is freaking out (my mom is very private - I know just how freaked out she is because she told me about it at all).
I'm not sure how to advise her. I think that if she paid them a $5 a month, they couldn't call her anymore. Is that correct? I also told her she could just tell them to kiss her ass. Really, what can they do to her? She doesn't have anything for them to take away from her. I also told her she could apply for Medicaid. I know she is eligible (she had to apply for her husband when he had to go to a nursing home). But she was so humiliated by that process that she doesn't want to do it for herself.
I'm so angry that this is happening. Medicare and her supplement should be enough. I'm so angry that in my mom's later years she is being harassed and made to feel ashamed that she can't pay her bills. I don't think she should owe anything at all!
I would appreciate any advice that you all might have for me to share with her.
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People on hemodyalysis at a center have access to a social worker a dietition and see a RN 3x per week and see an MD at least once per month. Some of theses services are probably mandated by Medicare or the goverment as terms of participation for the clinincs or providers of dialysis. Now I know your mother is on home dialysis, but that company that provides the machine and supplies, or her Nephrologist should have a social worker with them that she should be eligible to see. I suggest you have her make an appointment, and you go with her, and They are experts in this stuff.
Good luck.
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She should see if she can get on the Qualified Medicare Beneficiary (QMB) program, which pays for Medicare deductibles, coinsurances and copayments. It is not considered Medicaid, even though Medicaid pays the bills.
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People on hemodyalysis at a center have access to a social worker a dietition and see a RN 3x per week and see an MD at least once per month. Some of theses services are probably mandated by Medicare or the goverment as terms of participation for the clinincs or providers of dialysis. Now I know your mother is on home dialysis, but that company that provides the machine and supplies, or her Nephrologist should have a social worker with them that she should be eligible to see. I suggest you have her make an appointment, and you go with her, and They are experts in this stuff.
Good luck.
This isn't what it's really about....it's about what an aging parent or loved one has to go through when they are ill due to a really crappy health care system. The health care is pretty decent; it's this type of stuff that's not. NO person should have to go bankrupt or spend all their money to pay medical bills.
Have you looked over her bills to see what Medicare is paying and what the supplement is paying?? When my father had Medicare and a supplement years ago, pretty much everything was covered--he didn't owe anything. Are you sure that these bills have applied both Medicare and the supplement??? Can you doublecheck on that??---take a look at the bills to make sure what she's saying is correct.
I would have your mother call the hospital to make arrangements to pay what she can afford every month (but double check her bills first), even if it's just a little amount. Try to work things out with the hospital. The hospital also may have a fund/assistance she can tap into to help pay her bill. Doctors are not insurance people.
You might want to consider getting a power of attorney so you can help your mother with these things.
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So sorry your mother has to deal with this after being diagnosed with renal failure. Since she is freaking out about the bills, are you able to make a few calls on her behalf to help sort things out? You could call with her sitting next to you, or via 3-way calling if she isn't local.
Agree that the first step would be to call the billing department and ask if her Medicare coverage and supplement are being applied correctly. Next would be to call the supplemental insurance company to confirm that they don't cover these bills. Sometimes the problem is a mix up with the billing department.
She says she doesn't want to apply for Medicaid after the humiliating experience she had in the past. But, depending on the state she lives in, applying for Medicaid has gotten a lot simpler in the age of Obamacare. In many places, you can apply online, provided you meet the income guidelines. (For seniors on Medicare, this is ~100% FPL, or about $1000 a month, lower than the 133% FPL for working people in the states that have expanded Medicaid.)
Also agree with talking to the social worker in renal clinic: they want to be reimbursed, so they're motivated to help.
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She says she doesn't want to apply for Medicaid after the humiliating experience she had in the past. But, depending on the state she lives in, applying for Medicaid has gotten a lot simpler in the age of Obamacare. In many places, you can apply online, provided you meet the income guidelines. (For seniors on Medicare, this is ~100% FPL, or about $1000 a month, lower than the 133% FPL for working people in the states that have expanded Medicaid.)
Once someone is "disabled" they no longer are part of the expanded group for ACA Medicaid. The disabled, blind and elderly (>64) fall under the old Medicaid rules with both a resource and income test.
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Once someone is "disabled" they no longer are part of the expanded group for ACA Medicaid. The disabled, blind and elderly (>64) fall under the old Medicaid rules with both a resource and income test.
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You're certainly right about that:
https://www.medicaid.gov/medicaid-chip-program-information/by-population/medicare-medicaid-enrollees-dual-eligibles/seniors-and-medicare-and-medicaid-enrollees.html
I pointed out that the income limit for an elderly person is lower than for people in their working years but forgot to mention the resource test. Recources don't include your home, car, furniture, etc.
The op stated that the main barrier for his mother applying for Medicaid is the application process itself; was speculating that an online option may be available. I actually don't know the answer to that. Still, applying should be straightforward enough as long as she meets the income and resource tests.
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Due to HIPPA, there is not much OP can do to help mom by contacting her providers on her behalf beyond asking general questions*. What can be done is to hand hold mom to help herself. Pretty sure it's possible for a dialysis patient who is not indigent to still have virtually zero out of pocket costs. Yes, there is a system to learn and navigate, but it is a privilege she has earned, not charity. Her own pricklishness may be the root of the problem. Assume the goal is for her to have zero OOP expenses and then help her navigate the path to get her there. Yes, the system should be better, but it just isn't, so spend your energy figuring out the workarounds, not fighting it.
*If you try this, don't use your name or your mother's, just keep it general. If they hear a name, they may clam up for fear of HIPPA-related reprisals. Boy, has that well-intentioned act backfired. Total PITA.
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The Medicaid system is there for people who can't afford to pay their Medicare bills. The application process might not be fun, but it will help stop the calls and collectors and pay the providers (a small amount) for the care she receives, which helps them continue to provide the care and not go bankrupt themselves.
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What people said about Medicaid above.
Despite HIPAA and privacy laws, I was able to help a (disabled) family member get onto Medicaid. At some point she might have had to sign a form allowing me to speak as her representative. This was several years ago, and I don't remember. My family member is Medicare and Medicaid dual-enrolled. She pays maybe a couple bucks for her prescriptions, but everything else is covered.
If the op's mother doesn't quite meet the income limit, you can look into doing a Medicaid spend-down for medically needy people. Also beware of giving away assets to pass the resource test: Medicaid has a several years look-back policy for that kind of thing.
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What people said about Medicaid above.
Despite HIPAA and privacy laws, I was able to help a (disabled) family member get onto Medicaid. At some point she might have had to sign a form allowing me to speak as her representative. This was several years ago, and I don't remember. My family member is Medicare and Medicaid dual-enrolled. She pays maybe a couple bucks for her prescriptions, but everything else is covered.
If the op's mother doesn't quite meet the income limit, you can look into doing a Medicaid spend-down for medically needy people. Also beware of giving away assets to pass the resource test: Medicaid has a several years look-back policy for that kind of thing.
This. Maybe a social worker as others have suggested, or some kind of case manager from your local Office for the Aging can determine her Medicaid eligibility and help her apply. For the 65+ population, Medicare/Medicaid is a very good package of insurance.
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What people said about Medicaid above.
Despite HIPAA and privacy laws, I was able to help a (disabled) family member get onto Medicaid. At some point she might have had to sign a form allowing me to speak as her representative. This was several years ago, and I don't remember. My family member is Medicare and Medicaid dual-enrolled. She pays maybe a couple bucks for her prescriptions, but everything else is covered.
If the op's mother doesn't quite meet the income limit, you can look into doing a Medicaid spend-down for medically needy people. Also beware of giving away assets to pass the resource test: Medicaid has a several years look-back policy for that kind of thing.
This. Maybe a social worker as others have suggested, or some kind of case manager from your local Office for the Aging can determine her Medicaid eligibility and help her apply. For the 65+ population, Medicare/Medicaid is a very good package of insurance.
Agreed - There are Area Offices on Aging & probably a council for Aging. The Area Office on Aging has people who help explaining & assisting with Insurance - Medicare & Medicaid etc.
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Thank you all so much for your advice. I'll be asking her this evening is she'll let me go with her to her next appointment (she is SO private...).
This is a good community!
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Due to HIPPA, there is not much OP can do to help mom by contacting her providers on her behalf beyond asking general questions*. What can be done is to hand hold mom to help herself. Pretty sure it's possible for a dialysis patient who is not indigent to still have virtually zero out of pocket costs. Yes, there is a system to learn and navigate, but it is a privilege she has earned, not charity. Her own pricklishness may be the root of the problem. Assume the goal is for her to have zero OOP expenses and then help her navigate the path to get her there. Yes, the system should be better, but it just isn't, so spend your energy figuring out the workarounds, not fighting it.
*If you try this, don't use your name or your mother's, just keep it general. If they hear a name, they may clam up for fear of HIPPA-related reprisals. Boy, has that well-intentioned act backfired. Total PITA.
It is quite easy to speak to people, even with HIPAA. All you need is consent from the person which involves either the person being present and giving consent to each new person or POA/living will. I've help multiple people and my mother over 20 without any issue with the exception of needing to speak to supervisors who actually knew what they could or could not say.
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So sorry your mother has to deal with this after being diagnosed with renal failure. Since she is freaking out about the bills, are you able to make a few calls on her behalf to help sort things out? You could call with her sitting next to you, or via 3-way calling if she isn't local.
Agree that the first step would be to call the billing department and ask if her Medicare coverage and supplement are being applied correctly. Next would be to call the supplemental insurance company to confirm that they don't cover these bills. Sometimes the problem is a mix up with the billing department.
She says she doesn't want to apply for Medicaid after the humiliating experience she had in the past. But, depending on the state she lives in, applying for Medicaid has gotten a lot simpler in the age of Obamacare. In many places, you can apply online, provided you meet the income guidelines. (For seniors on Medicare, this is ~100% FPL, or about $1000 a month, lower than the 133% FPL for working people in the states that have expanded Medicaid.)
Also agree with talking to the social worker in renal clinic: they want to be reimbursed, so they're motivated to help.
I can't stress the importance of this enough.
it's NOT just your mom. It's EVERYWHERE. Even with private insurance.
- 10 years ago, I had my first kid. I got a bill from the hospital for $3000. I was sleep deprived new mom. I asked for an itemized bill. I compared it to my insurance EOB. Nothing matched. No names, no codes, no $ values, no combination of any of the 100 line items. I called the hospital, confused. They said "let me take care of it". They re-submitted to the insurance, re-coded. My bill was now $700 ($350 each deductible - mine and the kid's). How many people would just pay the bill?
- 2.5 years ago, my second baby had surgery. They don't do the surgery in our home clinic. So the ped referred us to the specialist, the specialist referred us to UCLA. We got the pre-approval and the code for the surgery, which was done at 9 months. Then, the bills started. Now note: my kid was double covered: HMO from my work and backup was PPO/ HSA from my husband's work. The surgery was about $20,000-$25,000 (combo of hospital and doctor). I don't even remember what the bills totaled. But the very first paperwork we got was from my HMO, a letter saying that they would not pay for the surgery because it was not an emergency. No shit, sherlock, that's why we got PREAPPROVED. In the end, it took 18 months!! to get it all paid for. At around 9 months we had our open enrollment, when I realized that my out of pocket cost for an outpatient surgery is $125. After dozens of phone calls, eventually the HMO said "oh, you are right!" (I have no idea how screwed my husband's insurance was over this, because they paid right away. Funny thing, BOTH were BCBS).
Then of course the doctor bills started. 18 months. Out of pocket cost: $0 because of the HMO/PPO/HSA. Tens of hours on the phone. (Some of this was because the insurance company will only pay if they are billed from our home clinic, so UCLA needed to bill the clinic, who would pass it on).
- My old boss just had to have a procedure that was pre-approved and $30k, and he's getting the same go around.
In any event, I know that she is stressed out, but I think you should help her out and call the insurance company and the hospital (or whatever). It may involve digging in to the actual coverage and pointing it out. I swear that insurance companies and hospitals, etc. just bill people in the hopes that they can get their money.
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Quick update: went with Mom to her appointment...visited with the social worker who said she would see if she can get it all resolved. She is ALSO going to see if she can get mom's supplement premium paid. Exciting news! We'll see what happens.
Thanks to all for the advice.
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Quick update: went with Mom to her appointment...visited with the social worker who said she would see if she can get it all resolved. She is ALSO going to see if she can get mom's supplement premium paid. Exciting news! We'll see what happens.
Thanks to all for the advice.
Good news! Thanks for the update.