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Old 11-13-2008, 06:12 PM   #1
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Advice needed on duties of Social Worker...Insurance?

My mom's primary insurance is Medicare, but she has two other medical insurances to fall back on...from the place she retired from and from my dad's as a surviving spouse.

Her own insurance is being skipped over (which is better than my dad's) and going right to my dad's.

I called Medicare and they told me they don't have a crossover to mom's insurance and that it is set up that way...NOT...it always bumped to mom's and then dad's. They tell me to call mom's insurance.

I call mom's insurance and I may has well have been talking to myself..."Oh, we don't do crossovers! It's Medicare's problem.

Each place is telling me it's not their problem. What do I do?

Can the social worker at the NH solve this for me? Is that part of their job? After all, my mom is a resident there and isn't their job to solve issues on behalf of the resident and the family? I know her quite well, and she's an absolute doll, so I know she'd help me out, I just hate to ask if that's not part of their job.

It's very hard for me to do all this phone talk between insurance companies and process all that is being said. I guess I'm about burned out from my mom and now my aunt in the rehab. Not to mention my own health concerns...I never dreamed 30 years ago that I'd be the one handling all this responsibility..but, someone has to do it and I'm the only one that is dependable in the area.

Oh well, thanks for letting me vent.

 
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Old 11-13-2008, 09:56 PM   #2
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Re: Advice needed on duties of Social Worker...Insurance?

Sunny, I am right where you are. I am so frustrated!

I have REAMS of paperwork to fill out for day care/respite for dad, and I called 5 different numbers before I got someone to help me with dad's supplemental insurance. And before they got too far, they needed me to fax my POA. And they told me what coverage he has, but it was so fast that I don't know what they said. Except - no crossover. I don't even really get what that means.

I surely never thought I would be dealing with this, either. It's exhausting. I guess we just plug on each day at a time. One piece of paper, one insurance call, one day at a time.

Hang in there. After all...what choice do we have?

...lil' deb

 
Old 11-13-2008, 11:52 PM   #3
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Re: Advice needed on duties of Social Worker...Insurance?

I have never had to deal with cross over. They both have medicare with BCBS supplement. Then they have Tricare which is for military retirees and it just picks up whatever is left over.

I did do benefits at my HR job and for LTC and I can tell you... keep calling until you find the right person to answer your questions. That might not be the first or fifth person you talk to but you will find that person eventually. If that doesn't work.... most states have an insurance commissioner or other such government official that is the people's watchdog over insurance companies. Call them. That is what they are there for The last resort... channel 3 is on your side... consumer complaint TV is amazing at getting results!!!

Good luck... there is nothing more frustrating than dealing with slipper insurance people.

Love, deb

 
Old 11-14-2008, 12:32 AM   #4
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Re: Advice needed on duties of Social Worker...Insurance?

Every nursing home is set up differently as to who does what. Why not stop in and have a chat with the administrator and explain what it going on and ask if they can assist you. My dad was in a nursing home that had a person there that took care of that sort of thing...it wasn't the social worker in that home but it was one that kept track the patients finances. Of course you have to be careful that they are honest and that you aren't signing mom's life away. Sometimes you can also go to your local Senior Center for guidance through the maze or just to get some advice. The retired sometimes will offer to assist you in such matters....or some have been through these things already and know what you should do. good luck.

 
Old 11-14-2008, 06:56 AM   #5
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Re: Advice needed on duties of Social Worker...Insurance?

Most skilled nursing facilities have a financial counselor, if your Mom's facility has a counselor, please sit down and have a talk with him or her. They can be a big help. You might also try contacting your local or regional Alzheimer's Association, they may have a person on staff who can help you sort this out.

The nursing facility has a vested financial interest in the process and wants to make sure they get paid, some of these counselors can cut through this insurance maze quite quickly.

 
Old 11-14-2008, 01:18 PM   #6
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Re: Advice needed on duties of Social Worker...Insurance?

Yes, try to get the social worker to help you. If that fails, go to an Elderlawyer. It is worth the expense to get a clear picture. Although they all talk in ''Legalese" with words we never heard of before, like crossover, they can present it in proper English if you keep asking, "What is that?" Eventually they will make it clear.

I have experienced problems with my own medical coverage. Having come from Germany in 2000, where your insurance was part of your job and all you ever did was hand your card to the doctor, hospital , practicioner or druggist, I had to figure out What is a co-pay? What is a deductible? I didn't even know what a "sick day" was, although I had worked in this country until 1969 before going to Europe. In Germany sick day meant you had a doctor's attest that you were sick. If you were sick 10 days, the employer had to pay you, if it was 40 days, he had to pay you. There were no expenses to have a hospital stay or an operation or rehab or dental work or glasses, outside of your monthly fee for medical insurance which was deducted from your paycheck. And that was on a sliding scale depending on your income.

So it took me a year to figure out how to go to the doctor over here, and later another year to figure out how to manage Mom's health care, nursing home, etc ... but with lots of patient explanations, I got it, finally! Before it drove me batty!

Love,

Martha

Last edited by Martha H; 11-14-2008 at 01:20 PM.

 
Old 11-14-2008, 02:46 PM   #7
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Re: Advice needed on duties of Social Worker...Insurance?

i think the social worker is supposed to help. if there is no social worker, then it would be the administrater. i am going through this with my mother right now. after almost 2 hours, i walked away with a headache, but i did get some info. keep asking.

 
Old 11-14-2008, 02:57 PM   #8
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Re: Advice needed on duties of Social Worker...Insurance?

Thanks to ALL of you for such educated replies. Gosh, I don't know whether I'm coming or going anymore; what a day it's been.

Anyway, I spoke with mom's social worker at the facility and explained it to her. She wants me to come in Monday morning and she will make some calls and hopefully get it straightened out. She said that, most definitely, she is the one to come to when I have problems of any kind; no matter what.

She knows how overwhelmed I've been with having mom there and now my aunt for rehab. This girl is very kind and always telling me that she will help me with anything; all I need to do is ask. She's an angel when I need one, that's for sure!

Hopefully, she can get this mess straighted out in her own eloquent way. Then she can explain to me what I need to do face to face!

Auntie is being released tomorrow for home after rehab from hip-replacement surgery...I'm praying everything goes okay for her and she can manage on her own. She's quite independent and doesn't like to be fawned over.

What a rough 3 weeks this has been...I guess that's how we earn our angel wings right?

 
Old 11-14-2008, 04:45 PM   #9
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Re: Advice needed on duties of Social Worker...Insurance?

Absolutely Sunny and I think you have a good start on yours. It is amazing where we find angels. I found one in a caregiver when Mom and Dad were at home, you found your social worker, little deb found gary... and the list goes on. It seems when we hit that wall sombody walks around the corner to give us a boost up and over it. I am glad you found somebody that can help you. I will keep your Aunt in my thoughts and prayers that she is able to handle life on her own and that you find time for some much needed rest and relaxation. Do something special for yourself this weekend... you need it!!

Love, deb

 
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