I spent the entire day on this one week anniversary of my surgery trying to navigate the frustrating system of home health care and long-term care insurance. I didn't plan on hiring an aide nor using my long-term care insurance, but it has become evident that I cannot yet take care of myself. I cannot get into the shower. I cannot get my meals from the kitchen to the recliner, the only place I can sit. I still have a little trouble getting up out of the chair and on to the scooter. I cannot get myself down the ramp from the living room to the porch. Most of all, my good friends are afraid of my being alone, especially if I fall. My sister Renee is coming Thursday night, and my friend Susan arrives right after she leaves, so I am looking for four days of home care.
My first call was to Genworth, my long-term care insurance. I discovered that in order to qualify for coverage I needed to prove that my recovery will be longer than three months. Since my recover actually will take three months -- three weeks in a cast and the remainder of the time in a boot -- my agent said that my doctor should simply write that recovery is the required length of time and then I can cancel my claim when I no longer need an aide. I wasn't going to tell the claims department representative that I was going to be in a cast for three months: that is ludicrous. There was no surprise when she told me that I wouldn't qualify for a claim.
My second call was to a local home health agency; the minimum number of days for an aide is two weeks. Scratch that. The next agency didn't have a daily rate, charging the same hourly rate for 24-hour care. I decided to try a different route and contacted my doctor's office to ask if they could make a recommendation, and I was surprised that she offered to write me a prescription for home care; supposedly, this would make it eligible for coverage from Aetna. That was logically followed up by a call to Aetna who confirmed that this was true; they would cover 90% of in-network home health care.
The process of getting an aide continued to be elusive. A call to the closest in-network agency revealed that my doctor's office had already sent in the scrip, but the agency only provides skilled care such as physical therapy and showering. They would not help with meals, which was a moot point since the scrip was for one hour two days a week. Two neighbors recommended Visiting Angels, an agency that provides both nursing and aide care. Since they offered a daily rate and thought they could fill the position, I thanked them and went back to Aetna.
The gentleman who answered the phone was much too quick to tell me I would be covered; I asked him for his name, and he told me he was only allowed to give out Steve H. He assured me that if my doctor gave me a scrip for home care, Aetna would cover it; I forgot to ask how much they paid for out-of-network agencies. My second call to Visiting Agencies put me on course -- they had an aide for me; the nurse could do the intake today. I just needed to pay the amount in full. I could submit a claim to my insurance. I am not hopeful about being reimbursed, but I have decided, with the help of caring friends, that it is money well spent.
My aide, Jennifer, will be here from Monday morning until Thursday evening when my middle sister, Renee, comes to my rescue. She will be able to accompany me to my post-op appointment with my friend Judy; it might take two people to get me in and out of the car!
As Judy said, you would spend that much on a trip in a minute; this is for my safety and well-being. It's money well spent.
My first call was to Genworth, my long-term care insurance. I discovered that in order to qualify for coverage I needed to prove that my recovery will be longer than three months. Since my recover actually will take three months -- three weeks in a cast and the remainder of the time in a boot -- my agent said that my doctor should simply write that recovery is the required length of time and then I can cancel my claim when I no longer need an aide. I wasn't going to tell the claims department representative that I was going to be in a cast for three months: that is ludicrous. There was no surprise when she told me that I wouldn't qualify for a claim.
My second call was to a local home health agency; the minimum number of days for an aide is two weeks. Scratch that. The next agency didn't have a daily rate, charging the same hourly rate for 24-hour care. I decided to try a different route and contacted my doctor's office to ask if they could make a recommendation, and I was surprised that she offered to write me a prescription for home care; supposedly, this would make it eligible for coverage from Aetna. That was logically followed up by a call to Aetna who confirmed that this was true; they would cover 90% of in-network home health care.
The process of getting an aide continued to be elusive. A call to the closest in-network agency revealed that my doctor's office had already sent in the scrip, but the agency only provides skilled care such as physical therapy and showering. They would not help with meals, which was a moot point since the scrip was for one hour two days a week. Two neighbors recommended Visiting Angels, an agency that provides both nursing and aide care. Since they offered a daily rate and thought they could fill the position, I thanked them and went back to Aetna.
The gentleman who answered the phone was much too quick to tell me I would be covered; I asked him for his name, and he told me he was only allowed to give out Steve H. He assured me that if my doctor gave me a scrip for home care, Aetna would cover it; I forgot to ask how much they paid for out-of-network agencies. My second call to Visiting Agencies put me on course -- they had an aide for me; the nurse could do the intake today. I just needed to pay the amount in full. I could submit a claim to my insurance. I am not hopeful about being reimbursed, but I have decided, with the help of caring friends, that it is money well spent.
My aide, Jennifer, will be here from Monday morning until Thursday evening when my middle sister, Renee, comes to my rescue. She will be able to accompany me to my post-op appointment with my friend Judy; it might take two people to get me in and out of the car!
As Judy said, you would spend that much on a trip in a minute; this is for my safety and well-being. It's money well spent.
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