How Much does it cost

What does it cost?

Ms. Obtuse recently fell and broke her left hip. Dr. Kildare decided she needed a total hip replacement rather than just a hip pinning. A referral was automatically called to a local acute rehab hospital. She was accepted for rehab by the hospital and transfer was planned for Ms. Obtuse.

On the third day, a Saturday, all paperwork was prepared and Dr.Kildare wrote orders to transfer Ms. Obtuse. When Ms. Obtuse’s son was called to transport her to the rehab hospital, he stated he did not have a car that day and another family member was working therefore also unable to transport. “Just call an ambulance to take her”, the son stated. The staff nurse called an ambulance without knowing Medicare’s guidelines for paying ambulance transportation.

Ms. Obtuse recovered from her surgery and had a successful rehabilitation. Four months later, she received a bill from the ambulance service for $780.00. This was the cost of a three mile, non emergent ambulance trip from the acute care hospital to the acute rehab hospital. At the time of transfer, Ms. Obtuse was able to sit upright in a chair and ambulate a short distance with the aid of a walker. Medicare guidelines state if a person is able to ambulate (even a few steps) and/or sit upright in a chair, ambulance transport is not covered.

You may ask, why Dr. Kildare or the staff nurse did not inform the patient of Medicare guidelines? Doctors and nurses do not know all Medicare or commercial insurance guidelines. Unless they work in an area that requires them to learn more than basic information, they will order what a patient and/or their support system requests. They could also ask why you do not know what your insurer pays for.

What will lack of knowledge about insurance coverage cost you?


Does Anyone care

Does Anyone Care?

Ms.’s Obtuse’s neighbor, Red, was admitted to the hospital with a high temperature and delirium.  He was elderly, lived alone and had many chronic medical problems.  Dr. Kildare received permission from Red’s adult daughter to treat.  Initially the neurologist wrote Red was not competent to make his own decisions.  Case Manager, Kegan, approached Red’s adult children about applying for guardianship for Red. Red’s daughter reluctantly agreed and started the process at the courthouse. 

Meanwhile Red was responding to treatment and the delirium was clearing. He did not want his children to be his guardian.  Finally the neurologist agreed Red was once again competent to make his decisions.

When Red was almost stable for discharge, Kegan presented him with discharge options.  Red could go to a nursing home for rehabilitation or home with assistance.  Red’s adult children rarely visited.  They had jobs and were busy with their lives.  They could not commit to helping Red at his home or Red staying at their homes.  Red was competent to make his own decisions but not safe to return alone to his home and handle his care.  He even had to go to and from outpatient hemodialysis.  He refused rehab at a nursing home even for a short time.  Therefore, at great cost he remained in the acute care hospital (rather than a sub-acute setting) receiving therapy until he was stronger and safe for discharge. 

Before leaving, Red stated “I guess I’ll just get a mail-order bride”.  Is this an idea whose time has come? How strong is your support system?


How much do you know about health insurance? 

Hello to everyone reading this blog.  I’m starting a blog to share my knowledge and experiences of assisting patients/clients and their support systems to navigate the maze of health insurance and health delivery systems.  Long ago, I discovered most people do not know and/or understand their insurance coverage, levels of care and community resources or the importance of a strong support system.  That’s to say nothing of their lack of understanding on body functions, disease processes or that adherence to “an ounce of prevention is worth a pound of cure”.  During difficult times people discover their true friends.  And in times of vulnerability, you learn just how strong your support system is.

I have worked in health care for many years in many different roles, with case management as the most recent.  I have been a certified case manager (CCM) for 14 years.  Case Management Standards of 2012 specifies a case manager’s duty is to:

  • Involve      the patient/client and/or the caregiver(s) in the decision making process.
  • Educate      all parties on insurance benefits, community resources and the transition      to available and appropriate level of care.

My goal is to instruct readers in health insurance basics along with some health care guideline and initiatives.  Knowledge empowers the patient/client to be more involved with informed decision making in routine or critical situations.  It will also spotlight some financial pitfalls for patients and/or their support systems.

My blog’s purpose is to “shed light on” the above topics.  I will use fictional characters to portray actual scenarios.  The doctor character is “Dr. Kildare”, a childhood television character.  The case manager’s name is Kegan which is combined letters from of my granddaughters’ names.  The support person is Ms. Obtuse for obvious reasons.  The names are not based on any known or unknown person.  My blog is fiction based on fact.

I hope my information will be entertaining and helpful for anyone who cares to read 

Be careful out there!