Photo courtesy of furryscaly via Flickr

Many of us have been in the situation of having an insurance claim rejected. Often it can be solved by simple documentation. It’s a nuisance, but they go away quickly. In other situations, the insurance company digs in and is adamant that you shall not be covered. In some situations, they’re dead wrong and with a good deal of effort, you can prove it. In other situations, you’re either in a gray area, or totally in the wrong. In all cases, there’s a chance you can get the insurance company to pay.

Understanding your coverage

The first thing to do is to spend some time reviewing your coverage. In most cases, you probably received the detailed information on your insurance in the mail. They typically document policies on their sites. You don’t have to be a lawyer to understand most of it, thought it might help. You don’t have to read it all either, because there’s likely a section or two that cover your specific situation. Skim most of the document and mark and thoroughly read the parts that apply to the current issue.

Insurance call centers

People who manage call centers typically measure performance on things like, ‘first-call resolution’, number of calls handled by agent, agent availability and cost per call. Their motivation to solve customer situations quickly and efficiently can work for you and against you, depending on how difficult your situation is and how far apart you and the insurance company are on the claim. Don’t think that by wasting their time that you can badger them into submission. What you can do is use their motivation to satisfy your needs quickly to your advantage. Most call-center staff are trained on the ins and outs of the policies and procedures and they often have key reference materials at their fingertips. Ask questions about your coverage. If they’re denying you coverage for a specific claim, ask how this situation could be avoided in the future.

There are some specific techniques that will help you when engaging with the call center:

1. Have paper and something to write with before starting the call.
2. Take the name of the person you get on the phone. Some call centers allow you to recontact the same person, so during the call, ask how you can recontact him, or her. At minimum, the person’s name, the date/time you called and some notes on what you discussed will help you in follow-up conversations.
3. If you talk to multiple people, try to understand whether they’re all frontline employees, or if some are supervisors, or management. It can help you if you have some idea of the structure of their organization and what each person has the authority to do for you.
4. Be respectful. Treating a call-center employee any other way will not help you and, in fact, could deprive you of an ally. It’s better to have them on your side than against you.

Insurance claims strategies

• Call the insurance company and get a clear explanation of the denial. Often denials of claims come with a terse three-word explanation and a code. Get them to explain exactly what the problem is and, if possible, a more thoroughly written documentation of the issue. At minimum, get them to tell you where in the policy you can read more about it.
• Enlist the health-care provider (doctor, or hospital, insurance billing staff) to help you, or give you suggestions on how to handle it. They have some incentive to help you because, if the insurance doesn’t pay, then they have to get the money from you.
• In some situations, insurance companies will have a ‘pay to educate policy’ that they can use at their discretion. For instance, if there was ‘an inappropriate emergency admission’ they might cover it in the first instance, but not in the future. It doesn’t hurt to ask.

Enlist consumer advocates

• Need Help Navigating Medicare? SHIP is Not Far From Home
• Need Help With Veteran Benefits?
• State Insurance Commissioner – See the link to State Insurance Departments on our State & Local Resources page
• How can a long-term care ombudsman help?

Perhaps you have some tips that others can use. Let us know in the comments.

Iwan Gabovitch via Flickr on Earth Day

For those seniors who are a little more in tune with the environment there is an emerging ‘green burial’ movement. The interesting thing about the green burial movement is the variety of options offered. Most can be classified into two major categories: cremation and whole-body burial. From there many of the choices have to do with where your remains will be placed. Whatever your senior decides, or you decide for yourself, make sure that your wishes are known. Be sure to document your desires on paper, and so that it is legally binding, consider consulting an attorney.

Cremation

Surprisingly, when all things are considered, cremation is one of the greenest options available. Cremation is a process that quickly reduces the body to its elements. The energy needed for a cremation is largely offset by the equipment and labor that is needed for a grave, or a mausoleum. Shipping cremated remains has a smaller carbon footprint than does shipping a body. And modern cremation is done with scrubbers to keep air pollution to a minimum. Check with the crematorium about their equipment. Also, an ‘immediate cremation’, one without a casket or viewing, is generally the most affordable method of preparing the deceased.

Cremation is considered final disposition in just about every state, and thus a cemetery plot is not necessary. Ashes can be shared among friends and family, and scattered in a place that was important to the deceased, or put in ‘scattering gardens’ at your church. Eternal Reefs provides an alternative resting place for someone’s ashes. They mix the ashes with an eco-friendly concrete, forming a ‘reef ball.’ The balls are placed on the seabed, creating structures that attract marine species.

Whole-Body Burial

There are also a number of options for whole-body burial as well. Much of the focus for green burial is avoiding the chemicals that embalming puts in the body and thus the ground. Where toxic formaldehyde and mercuric chloride are used in the typical burial process, with green burial the body is refrigerated, or kept in dry ice, prior to the funeral. Then the body is placed in a cotton or hemp shroud before placing it into the grave. Biodegradable pine, cardboard, or wicker box, is used without a concrete burial vault.

As with cremation, location plays a factor here too. Funeral homes and cemeteries are offering green options. The Green Burial Council has a regional locator to help you find someone near you that offers these services. Some burial services have conservation areas where remains can be buried within land that is cared for in an environmentally friendly way.

If you’re truly serious about going out as green as possible, consider the rest of the arrangements surrounding your funeral. Some recommend that you ask that friends and relatives limit their travel for the funeral. Grist recommends, “Everything from using recycled paper plates to insisting on local wines and microbrews…”, and, “Just be sure to stress simple ideas and make sure to spell out how important it is to you.”

Helpful Links

There are a lot of Green Burial resources. Here are some of the better ones:

• How to green your funeral
• Environmentally Friendly Death and Funeral Choices
• Green Burial Council
• Natural Burial Company
• The Green Funeral Site
• Memorial Ecosystems
• Forever Fernwood

Related SHF Links

• Pre Paid Funerals: Weigh Your Options Carefully
• Arlington National Cemetery Eligibility Requirements
• Plan a Funeral for $800 or Less
• Funeral Resources: Whether You Need Them Now, or Not

If you can, don’t jump in with the news first thing. This may be difficult if your presence at their home, or on the phone, is out of the ordinary. Ask them how things are going and/or how they’re feeling. A few open-ended questions is a good way to start the conversation. Be sure to listen, and don’t be quick to fill the silence. Let them talk if you can.

When you feel their side of the conversation begin to dwindle, it’s your turn to talk. “Mom/Dad, I came here to tell you that…” If we’re talking about a death of a family member, or friend, don’t worry about being particularly eloquent. You can say, “I came to tell you that Tom died.” Or you can use, “passed away”. If you want, you can preface it by saying that you have ‘sad news’, or that ‘there’s no easy way to say this’. Don’t beat around the bush, but don’t rush through it either.

From here on in, your job is to convey the relevant facts, be a good listener and to provide comfort. Let them talk. Answer their questions as well as you can. Let them lead the conversation. Try to just listen and be open to a range of feelings. Let your parents express all their feelings, even if they’re hard to listen to. Talk about your own grief, feelings, and memories, and let your parent know that he’s loved and that you’ll do your best to support him throughout the process.

Keep in mind that everyone reacts differently to bad news. Some people are more emotional than others. Make sure that you’re prepared to break the news by being as in control of your emotions as possible. If they yell, remain calm and try to calm them. If they cry, comfort them. They may just remain silent, letting the news sink in. If they do that, put your arm around their shoulders and show sympathy.

On the other hand, if you don’t think you’re up to it and just can’t do it, consider asking another family member, or a minister, to do it.

You can see how doctors are taught to break bad news using Robert Buckman’s Six Step Protocol for Breaking Bad News.

If you’re a doctor, you probably already know his book: How to Break Bad News: A Guide for Health Care Professionals

That’s why Getting Things Done (GTD) has become so popular among the Internet crowd. Those of us who are regularly online, on the Blackberry, or iPhone, manage to pack the day with interruptions, misdirections and a level of productivity that leads to a stressful life. Helping seniors can be particularly rewarding, but only if we can reduce the stress.

The main tenant of GTD is that a stress-free day is attained through recognizing that the process will manage all the balls in the air for you. While the process takes a little time to get used to, it’s not particularly complicated, nor could it be to be effective.

The overall workflow follows five main steps:

1. Collect
2. Process
3. Organize
4. Review
5. Do

Initially collecting can be a very long process. It’s gathering everything you want to do, or need to do, into buckets–your email inbox, your physical inbox, etc. The idea is to get everything that’s in your head into an inbox and ready for processing. All of these buckets are processed, or emptied, at least once a week.

When processing a bucket, a prescribed workflow is followed:

• Start at the top.
• Deal with one item at a time.
• Never put anything back into ‘in’.
• If an item requires action:
  • Do it (if it takes less than two minutes), OR
  • Delegate it, OR
  • Defer it.

• If an item does not require action:
  • File it for reference, OR
  • Throw it away, OR
  • Incubate it for possible action later.

In the organize phase, there are four set of list that you’ll maintain:

• Next actions – For every item decide what the next action that needs to, and can, be taken. It might be make a call, send an email, or schedule a meeting. While there are many items that are required to accomplish an item, there is only one ‘next step’.
• Projects – Projects are things that go on for a period of time and need revisiting on a periodic basis to make sure that there is still a next action associated with it.
• Waiting for – When there is someone, or something, that you must wait for, it goes here. These items are periodically reviewed to see if there is something that can be done to move the item forward.
• Someday/Maybe – These are items that you legitimately want to do, but you’re not ready to start…like learn Russian.

Review
Really two things fall into this area. The first is to review the next actions at least once a day. During the review, you should be determining the most important action that needs to be done immedately. The book covers a number of strategies to make the review step more effective.

At least once a week, you should review all of your outstanding actions, projects, and waiting fors.

Do
Basically the “Do” phase takes some emphasis off of the organizing and puts it on…Getting Things Done.

While certainly not for everyone, Getting Things Done will help many of you enjoy the time you spend with your parents.

Related Links

Tech Junkies Crazy About ‘Getting Things Done’ (NPR)

43 Folders (productivity site and big fans of GTD)

The concept of ‘sharing the care’ was not specifically designed with the elderly in mind, yet it’s extremely applicable. The book was written by a couple of women who, among others, were were formed into a group at the suggestion of Dr. Sukie Miller who was treating a patient with a terminal illness. Ultimately it lead to others to ask how they could do it, then a book and ultimately a website.

I think one of the things that appeals to me about this is that when someone has terminal illness, and we’re not a primary caregiver, it’s hard to know how to help…and we often don’t. Share the care makes it easier to know what to do. Sharing the care decreases that chance of burnout and increases the chance that the person in need will get the quality of support they deserve while helping friends and family to know when and how they can help.

While managing the first group, some issues came up regularly and ultimately were turned into seven principles for caregivers.

1. Sharing responsibility is the key to not “burning out.”
2. It won’t work unless everyone gains something personally.
3. Know your limits and stick to them.
4. There’s no one right way to do it.
5. Anyone who wants to help should be encouraged.
6. Trust the group; support each other.
7. Keep your own life in good working order.

Again, the thing that I find particularly appealing about this approach is that it’s a loose and fairly unstructured, organization. The commitment can be low when need be. People can step in to fill the gaps where needed. If someone has to drop out for awhile, they can. The points that go with the first principle do a nice job of illustrating this:

• No one person has to be in charge all the time.
• No one person has to deal with every crisis.
• No one person has to be “on call” every single day.
• No one person has to make all the decisions, all the time.
• No one person has to try to run his own life plus the entire, complex life of his loved one.
• Let the others do their share. They want to. They need to.

If you, or someone you know, is faced with caring for an individual with Alzheimer’s, Parkinson, or another terminal illness, Share the Care.

Flickr by markhillary

A USA Today article by Christine Dugas reports, “to many people, the idea of prepaying for a funeral makes a lot of sense. It can remove a big financial burden from your loved ones, make a stressful time easier for them, and ensure that you will get the kind of funeral you want.”

However, there is a considerable amount of research out there that points out the many pros and cons of prepaying for your funeral.  It is imperative that you weigh these items carefully.  Every situation is unique.  It may also make sense to speak to a certified financial planner and/or elder law attorney in your state to determine whether it makes sense for you to do so. They will be able to take state laws, your financial picture, and a host of other factors into consideration.

The USA Today article by Dugas provides consumers with a list of factors to take into consideration when determining whether they want to go ahead and prepay their funeral. Some are as follows:

1. Consider prearranging your funeral without paying for it in advance.
2. Check state regulations on prepaid funerals. The federal government does not regulate prepaid funerals.
3. Make sure you know exactly what you are buying and the terms of the agreement(s). (e.g., What is included in the plan? Can you get a refund if you change your mind? Is the plan portable if you move?)

Visit the USA Today website for the complete article and a thorough analysis of the tips outlined above.

The State of New York provides readers with a great document, entitled, “Before Prepaying Your Funeral, Know Your Rights.“  This document will also likely address many questions/issues that you had not anticipated.  Please keep in mind that any regulatory information found in the article may differ if you live in a state other than New York.

In honor of my father’s birthday, I thought it would be a nice idea to share the eligibility requirements with you for burial at Arlington.  The requirements I list here are very high-level.  Please visit the official Arlington National Cemetery website for a complete list of the detailed eligibility requirements for burial there.   

High-level requirements are as follows: 

Active duty members of the Armed Forces (except if serving on active duty for training only.)

A veteran retired from active military service with the Armed Forces

A veteran retired from the Reserves, drawing retired pay, and who served on active duty (60 years of age or over)

Former members of the Armed Forces who were separated for medical reasons prior to October 1, 1949 (30% or greater disability)

A member of the Armed Forces who was rewarded any of the following: the Medal of Honor, the Distinguished Flying Cross (Navy Cross or Air Force Cross), the Distinguished Service Medal, Silver Star or Purple Heart

President of the United States or a former President of the United States.

Former member of the Armed Forces on active duty who held:  Elective office of the U.S. Government,  Chief Just of the U.S. or of an Assoc. Justice of the U.S. Supreme Court, an office listed in 5 USC 5313 or 5313, the chief of a mission classified under provisions of Section 411, Act of 13 August 1946

Prisoner of war who served honorably in active military, naval or air service and who died on or after November 30, 1993.

The spouse, widow, or widower, minor child, or permanently dependent child and certain unmarried adult children of any of the above eligible veterans.

A widow or widower of: a member of the Armed Forces lost/buried at see or missing in action, member of the Armed Forces interred in an overseas US military cemetery maintained by the American Battle Monuments Commission.

Surviving spouse, minor child or permanently dependent child of any person already buried at Arlington National Cemetery.

Parents of a minor child or permanently disabled dependent child of a person already buried at Arlington National Cemetery.

Former member of the Armed Forces may be buried in the same grave as a close relative already buried and is the primary eligible

The topic of end-of-life, like so many things that we cover, is something that most of us don’t know anything about until we have to.

You can listen to the interview at the WAMU 88.5FM site.

Robert Lawton via Wikimedia Commons

Perhaps I’m not particularly sentimental, but after the medical community is done with my body, I want to be cremated and have my ashes thrown in the eyes of my enemy. And like so many others, my end-of-life plans remain incomplete. I still have yet to write the list of enemies.

If you, or your loved ones, won’t do without a ceremony, it’s not necessary that they spend thousands for it, though that’s what could happen if you leave it up to the funeral industry.

According to an article on MSN Money:

The average funeral in the United States costs $6,500, according to the National Funeral Directors Association. The true sum can easily reach $10,000 once a burial plot, flowers and other costs are included, the AARP says.

Some suggestions that they give include considering direct cremation (without a funeral service or viewing), or selecting a simple casket, or even direct burial–the deceased person is interred quickly, without a public viewing or any of embalming, cosmetology, or funeral services.

For more on a Funeral for $800 or Less

POLST stands for Physician’s Order for Life Sustaining Treatment.

A POLST Paradigm form is a brightly colored, medical order form, used to write orders indicating life-sustaining treatment wishes for seriously ill patients. It addresses two needs. It turns treatment wishes of an individual (something you might find on an advanced directive) into actionable medical orders for emergency responders, and then makes it portable.

It solves the problem that EMS generally can’t act on medical wishes for withholding treatment unless a doctor is involved. The POLST document is signed by the patient and their doctor in advance of the possibility of the arrival of emergency care. It doesn’t take the place of an advanced directive because it’s only used in very specific situations. There’s a great FAQ from the Oregon site and a Word document from the Washington State Aging & Disability Services Administration.

The Oregon POLST covers the following areas:

• Cardiopulmonary Resuscitation (CPR) vs Do Not Resuscitate (DNR)
• Medical Interventions
• Antibiotics
• Artificially Administered Nutrition

It’s not available for use in every state, though there are efforts in many states to adopt the POLST Paradigm. You can see which states honor them on the POLST site. As of September, 2008 there were about nine states that honor a POLST.