We’ve posted before on Medicare insurance appeals for Part A/B, Medicare Advantage, and Part D. We’ve even posted on doing battle with insurance companies. The fact is, insurance appeals are time consuming and can feel like doing battle. If you can avoid one, why wouldn’t you? How likely is that you’ll have to appeal an insurance/Medicare decision? I don’t have the statistics, but I suspect that most will do it in their lifetimes. If you haven’t had to appeal, ask a couple of people. Odds are they have.

If you believe that there’s a chance that you’ll want to appeal in the future, why not reduce that chance by spending some time understanding your coverage and what it takes to avoid the calls and letter writing? Consumers Union and The Henry J. Kaiser Family Foundation did, “A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan, 2005 Update” that’s all about how to deal with problems with your insurance. But the gem in there is, “a checklist for diagnosing your coverage”

The checklist covers many of the triggers that will put you in a situation for an insurance appeal. For instance, it asks you to check the medical services for which you need a referral from your primary-care physician. Sure you may know some of them, but if you dig through your insurance coverage forms and identify them in advance, you’ll reduce the chance of a denial of coverage.

There are a number of checklists that you’ll want to fill out:

• My primary-care physician has the following requirements for obtaining referrals
• My primary-care physician can refer me to specialists who
• I have reviewed the Exclusions and Limitations section in my Evidence of Coverage. My health plan will not pay for, or limits, the following services
• My plan will cover services at the following hospitals
• What should I do if I need care while I am out of my plan’s service area?
• Although I can use out-of-network doctors for most services, I cannot use out-of-network doctors for the following services
• If I use out-of-network providers, I will pay

So, here’s what you need to do:

• Print the form a checklist for diagnosing your coverage
• Fill out what you can from reading your plan
• Call your plan provider for the information you don’t have

This won’t guarantee that you won’t have a reason to appeal, but it should give you some peace of mind that you’ve reduced your chances a denial.

And, if you do have to appeal:

• Turned down for a Medicare Part A/B medical expense? Appeal! Here’s how
• How to Appeal Medicare Advantage/HMO coverage denial
• How to Appeal Medicare Part D prescription drug coverage denial
• Doing Battle with Insurance Companies

The Senior Organizer: Personal, Medical, Legal, Financial
The title is pretty self explanatory. This is a book, largely of forms that helps organize critical information that will be important during medical emergencies, diminished mental capacity and ultimately the death of a loved one. The Senior Organizer has a place to put all the information that you’re going to need for a number of situations.

Up front, the organizer has an index to the most important information in the book for emergency situations. It simply points the reader to the most important pages, like: specific information on the senior, emergency contacts, medications and other information stored in the book that can be important to have in an emergency. Overall, the book has two major sections after that that contain “personal & medical” and “legal & financial”.

The personal and medical section includes everything from doctors, doctor visits and prescriptions, to insurance and contact information.

The legal and financial is as you would expect, including information on banks, taxes, real estate holdings, insurance, health directives and end-of-life documents like wills.

This may seem like something you could do on your own, and it is, but the value that the editors of The Senior Organizer bring is their thoroughness and that they’ve packaged it into a very usable book. A thoughtful bonus is that buying the book entitles you to free downloads of new pages if you have to revise or add anything, or if you want to create a notebook instead of keeping it in a paperback.

One caution that I would make is that the book has places for information (Social Security number, date of birth, and credit card numbers) that would be ideal for identity theft, or outright theft. It should be agreed that this kind of information be kept in a more secure location.

Family Caregiver Organizer: A Personal and Medical Journal for Care-receivers and Their Caregiver(s)
The Family Caregiver Organizer is singularly focused on health care and, I would argue, on individuals who receive a lot of health care.  The organizer is spiral bound and a little friendlier for every day use than The Senior Organizer. The bulk of the organizer is monthly logs that include: My Calendar, Questions for the Doctor, Lab Tests, Medications and daily logs among other things. There are six months of logs and you can order more pages.

Up front is, “All About the Care-receiver”, including sections called My Health Now and My Health History.

The organizer includes a Family Caregiver Answer Book, a reminder booklet for caregivers called, Caring for the Caregiver and a File of Life, covered recently here on SHF.

My take? I’ve ordered both for my parents.

The Agency for Healthcare Research and Quality (U.S. Department of Health & Human Services) have a page on tips that you can employ in helping getting the best healthcare possible through reducing the number of inevitable errors that may happen. As you might guess, the number one way, “is to be an active member of your health care team“. Here are some others that we like:

4.   When your doctor writes you a prescription, make sure you can read it.
5.   Ask for information about your medicines in terms you can understand—both when your medicines are prescribed and when you receive them.
10.   If you have a choice, choose a hospital at which many patients have the procedure or surgery you need.
14.   Speak up if you have questions or concerns.
20.   Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources.

For the full list, check out their 20 Tips page.

An article on Nolo.com provides a great checklist of action items for getting your recently widowed parent’s affairs in order after the death of their spouse. 

Assets.  Take inventory of brokerage accounts, bank accounts, retirement plans, insurance policies, real estate, items in safe deposit boxes, etc.

Life Insurance.  Determine whether your parent is the beneficiary of a life insurance policy.  If so, submit a claim for benefits.

Benefits.  Determine benefits your parent may be entitled (e.g., pension, veteran’s benefits, social security, etc.)

Jointly Owned Assets.  Change the title on any property s/he owned jointly with the deceased spouse.  The title should now show that s/he owns the property alone.

Will and Trusts.  Update your parent’s plans for leaving property at death.

Avoid Probate.  Change title documents and review your parent’s estate plan.

Insurance Policies.  Modify, cash out or cancel any policies on which your deceased parent may be named as the beneficiary.

Living Will.  Have your surviving parent prepare a living will to communicate his/her health care wishes and name a trusted person to oversee care, if need be.

Financial Power of Attorney.  Have your parent name a person to handle his/her financial matters in the event s/he becomes incapacitated and unable to handle his/her own affairs.

Documents.  Help your parent set up a well organized filing system so you can find paperwork when it is needed.

Link to Nolo.com for more additional details.

The article covers some basics like calculating the value of your estate, how to help your heirs stay out of probate, avoid taxes and the like. It’s a good article, but the part that I liked the best was the checklist of six things every family needs:

• A will
• A health-care proxy
• A living will
• A durable power of attorney
• Life insurance
• Disability insurance

If money matters, or end-of-life discussions, are difficult to initiate between you and your parents, one way to introduce the topic is to discuss what you’ve done, or what you might do.

How many of these do you have?

According to the Center for Disease Control and Prevention (2006), “more than one third of adults 65 and older fall each year in the United States.” 

They further report that “in 2005, 15,800 people 65 and older died from injuries related to unintentional falls; about 1.8 million people 65 and older were treated in emergency departments for nonfatal injuries from falls, and more than 433,000 of these patients were hospitalized” (CDC, 2008).

The CDC recommends that seniors take the following precautions to try and prevent falls:

• Exercise regularly
• Have a medical professional (physician or pharmacist) review their medications (prescription and non-prescription)
• Have an eye doctor check their vision (yearly)
• Improve in-home lighting
• Eliminate hazards in the home that can lead to falls.

The American Association of Retired Persons (AARP) provides a fantastic checklist for reference when providing home improvements to help prevent falls. 

If you know of a low-income senior citizen that’s home is in need of updating, please refer them to Rebuilding America (800.473.4229).  This is a national organization that is dedicated to repairing and modifying the homes of low-income homeowners.  They have programs especially targeted to the elderly allowing them the opportunity to age in place.  Localized information can be found on their website under the “Find Your Local Affiliate” link.

Postcard c.1900

Today’s Caregiver Magazine online has a good set of tips for caregivers to help get a little more organized for the new year. It looks like a good list of new years resolutions.

Some of the great tips include keeping complete records of medicines/interactions, doctor appointments and medical information… which is a better way of saying that you’ll get more organized.

They also recommend making sure that there is an up-to-date advanced directive and last will and testament. You might also consider a Five Wishes document.

If it hasn’t been done lately, have an insurance analysis done for home/renter, life and other insurance.

Their last recommendation is to clean out the medicine cabinet of all expired and unused medicines. If you do find some, please check with your local recycling center, drug store, or hospital to determine the proper way to dispose of them.

For all ten tips click here.

1. What plans are available to me?
2. Does the plan cover pre-existing conditions?
3. Do my doctors accept the plan?
4. Does the plan cover my prescription drugs?
5. Does the plan cover medical equipment?
6. Does the plan cover dental, vision, hearing and other care?
7. What are the premium costs?
8. What other costs do I need to know about?
9. How are the plans rated?
10. What if I don’t make any choice?

If you’re moving, or helping a senior move, one thing to consider is the potential effect that it will have on Medicare Advantage (Part C) and Part D plans. If the move is long distance, there’s a good chance that new Medicare plan(s) will be in order. If the move is within the same city, it’s likely that your current plan will still work. Either way, it’s a good idea to check with the current plan to see if you’ll still be in their coverage area.

Moving out of a Medicare plan coverage area, raises the opportunity to choose plan that covers your new home under a special election period (SEP). Check www.medicare.gov for a plan in your new area. It’s a good idea to review the details of your current plan on the same site to see how the in your new neighborhood compare. Once you’ve chosen a new plan, contact the provider for an application and any special instructions you may need to follow. And by all means, check with Medicare (800-633-4227) to see if there’s anything you may have missed.

Beyond your magazine subscriptions and other accounts, here are some places that you may want to contact to change your address:

• Post office
• Medicare
• If you’re receiving veterans benefits
• IRS
• Your state treasury
• Your Medicare Advantage/Part D providers

Other resources that you may consider:

• National Association of Senior Move Managers
• 10 Tips to Help Older Adults Move
• AARP: Get Moving: Using a Moving Company