The AFH wanted mom to change to a doctor on this side of town that is familiar with them so they could call in when they needed meds, etc. They gave me a list of preferred doctors.
I don't particularly care for her doc anyway and he's 30 miles away. So I call a few of these new ones.
None of them would take mom's HMO. They only take Medicaire. Mom has a medicaire card and I thought her hmo was only a supplement. Fianlly, the last one I called said that with mom's HMO, after the first of the year, they cancelled her medicaire!
What? Don't they have to write and tell you or let you know they are doing that?
I decide to just call her old doc for the meds she needs, tell him the whole, long tale of woes and work with him till I can find another doctor. I called for 2 days and he does not return my calls. I've left messages, talked to his nurse, told them it's an emergency.......nothing.
Finally today, I told the AFH that he just hasn't called me back. Meanwhile, Mom is raising cain, combative and cussing them and accusing them of stealing. She's still ranting about the kidnappers who picked her up at her home and took her there. She has no memory that she has been with me for months and months.
"G" told me today that she WOULD take care of it. She would call him, pick up the meds, and I could pay her tomorrow. Mom is up every morning at 4am with her bag packed.
Anyway, I called her HMO to find out what the heck happened. I guess it was part of some bill that passed and went into affect the first of the year. No need to warn you, customer service says. Her HMO has the same benefits as Medicaire.
I asked if it paid for nursing homes when her money ran out.
He says, NO! It will pay for in-home nurse's aides.
Sorry, I don't know anything about HMOs. I do know that we paid for Mom's ALF and the AD unit from her money. Dad's insurance and Medicare wouldn't cover anything but the medical part of her care - no room, food, and such. It ought to be a crime.
You do have confirmation that you had nothing to do with your mother's worsening behavior, not that that's much comfort. On 2nd thought, it should be a great comfort to know that you did as well with no experience as G is doing as a nurse with 16 year's experience with AD patients. You did well!!
Medicare does not pay for nursing homes. It does pay for rehabilitation for a short time after an operation, injury etc. That's how my Mom got some help from them, but as soon as it became obvious that she was not learning how to walk, they dropped her. You have to apply for Medicaid, and they only take people in dire poverty.
An HMO is not a supplement to Medicare but a substiture for it. You agree to have the portion of your social security check that would have been withheld for Medicare sent right to your HMO.
After that you do have all the benefits of Medicare, BUT you are required to stay in their system, use their doctors, etc.
There would not be any great benefit to changing doctors now. I believe it is much harder to get out of an HMO than to get into it. The change that went into effect Jan 1 pertains to medicines. Many of the HMOs have their own drug system as well, and may have automatcially entered your Mom into one of the new Part D plans as part of her membership in the HMO. That was not illegal. It probably does save as much on meds as the Medicare programs do, and is cheaper.
It is possible that when all her money is gone she can still apply for Medicaid - that is not a part of Medicare and by no means happens automatically - you have MOUNTAINS of paperwork - but a state run progam. Medicare is federal.
Hope this helps
Sally, I don't think the NH could legally throw Mom out, but they could send bills to her children. Whether or not it would be legal not to pay them is a question. We can't all lose our good credit rating by having unpaid bills!
It did help me see that I was doing the very best I could. I felt so guilty when I learned she wasn't taking her pills. But she is taking them there, they make certain, and it made no difference. G says she is just up/down all day long. Fine/then combative. She says Zoloft just isn't enough now.
Yes, we were paying for everything, too, from her money. I knew medicaire wouldn't pay until all her money was gone. But anywhere I've taken her; doctors, hospitals, prescriptions, they always wanted her HMO card and her Medicaire card. Even G made a copy of her medicaire card. I thought it was something you had to have, whether you actually used it or not.
It amazed me that they could just cancel medicaire and leave you with the hmo so arbitrarily, no notification, etc. It's deducted from her ss check. I guess when she turned 65 and signed up for ss, she had a choice of 3 supplement plans. Everyone on the plan she chose, had medicaire cancelled at the first of the year.
Sally, I'm not sure what they'd do if someone is depending on that money from medicaire. Makes you wonder? We weren't depending on it and knew it would be awhile before we needed it to kick-in. It just upset me that she doesn't even have it and we were never notified.
I think my brothers felt like that, too, Sally. A little surprised that I'd been taking care of her in such a state when even the AFH is trying desparately to get her new meds.
I hope we can get her settled down soon. This is disturbing for us as well as her. I told dh last night, it will feel so good to see her calm again.
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