Another Humana policy you should know about.

On Tuesday March 10th my father was rushed to the Christus Spohn hospital in Corpus Christi.

In the short time that we were still hopeful that he could be stabilized, we hoped to have him moved to Austin where my sister & I could spend more time with him as he healed. The social worker at Christus Spohn worked that end of the information gathering and we had two great doctors here in Austin ready to be Dad's admitting doctor once the transfer was okayed.

The social worker did her best, but sadly informed us that Dad's Humana coverage was only regional, so even if we could physically bring him to Austin, none of his medical needs would be covered until April 1st since any requested changes go into effect at the first of the month.

In our case, dad never stabilized, and passed away in Corpus Christi on March 14th.

One of the many lessons we learned out of this tragic incident, is that you need to be sure that everyone you care about has PPO insurance so they can get medical support when and where they need it.

Taking it a bit further, I'd love to find the insurance company that would waive the timing requirement so that patients could be transferred to a hospice or other facility near their family when their time here on Earth is short.

Where is the 'human' in Humana?

Well, Humana has denied Keith the meds he needs. Don't get me wrong, they want him to have medroxyprogesterone, they just don't want to pay for it. Which adds about $96/month to our healthcare costs. Which makes me wonder how Humana can change a prescription plan without notice? And what do the people do who can't muster up the extra $96+ per month?

Keith's doctor is going to challenge this with the old "the patient needs this medication to breathe" defense. We'll see if that works.

Terri Johnson -- A Place for Mom

I received this email last Tuesday, the day that Dad was admitted to the ER at Christus Spohn Hospital in Corpus Christi. At that time we still had the hope we could move Dad up here to be closer to me and my sister. I spoke with the management of each of the places Terri Johnson recommended and was impressed with the kindness, warmth and genuine interest in making this next phase of Dad's life fun, safe and interesting. Unfortunately, we never had the opportunity to get Dad settled here in Austin.

Terri Johnson is a great asset to her company, A Place for Mom. She knows the market well and respected everything we shared about Dad's situation, including the budget! Her insight and compassion made a huge difference.

Although we were not able to utilize this information for Dad, I wanted to share it with all of you so that you might benefit in your own situation.

Ruth

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Thank you for contacting A Place for Mom. As your Eldercare Advisor, I am here to answer questions and provide you with referrals and details on senior care options in your area. Again, there is no charge to you or your dad for our services.

As we discussed, I am sending you a short list of communities that should meet your dad’s needs. I can help you set up a schedule to tour, and please feel free to contact our partners listed below to learn more and arrange tours. The selected care providers may also call you to schedule a visit. After you tour, give me a call or I will contact you and we can discuss if they met your needs. If not, I can offer more options for you.

Please call or e-mail me anytime! I am always interested in knowing how your search is going and am ready to assist you in any way I can.

Highland Estates1500 North Lakeline DrCedar Park, TX 78613
Contact: Julie or Joe Rowlette Phone: 512-259-3318

Click here for directions to this community.

Parkwood Meadows310 Chisholm TrailRound Rock, TX 78681
Contact: Debbie or Don McCowan Phone: 512-255-0886

Click here for directions to this community.

Parsons House Austin1130 Camino La CostaAustin, TX 78752-3969
Contact: Michael McKee Phone: 512-454-0524

Click here for directions to this community.

A great resource to check out is A Place for Mom's Family, the first online community website set up specifically for the families of aging loved ones to talk about eldercare. Find or share tips on moving mom or dad, legal matters, financial aid for Veterans, Alzheimer's care, dementia and so much more. Join today!

I look forward to working with you! Please keep me in the loop on what you hear regarding your dad’s prognosis (I will keep my fingers crossed for him).

Warm regards,

Terri Johnson
Eldercare Advisor
(877) 386-8023
terrij@aplaceformom.com
www.aplaceformom.com

http://elder-care-community.aplaceformom.com
Join "A Place for Mom's Family" - The first online community website set up specifically for the families of aging loved ones to talk about eldercare. Find or share tips on moving mom or dad, legal matters, financial aid for Veterans, Alzheimer's care, dementia and so much more.

A Place for Mom, Inc. is a nationwide information service about eldercare options including nursing homes, assisted living facilities, adult family homes, independent living and home care agencies. Our role is to provide information and options that meet a loved one’s stated needs and preferences. A Place for Mom, Inc. has assisted over 450,000 families in finding care and housing for their loved ones since it began in 2000.

Facilities or agencies may be included in our service if they are appropriately licensed by the state in which they operate. If a participating facility informs A Place for Mom, Inc. that it has lost its license, for any reason, or if A Place for Mom, Inc. has received complaints of significant dissatisfaction by consumers which are documented and can be proved, the facility will be excluded from the A Place for Mom, Inc. information service. A Place for Mom, Inc. does not own or operate any of the facilities or agencies to which it refers.

In order to provide the information service to consumers at no charge, participating facilities or agencies pay a fee to A Place for Mom, Inc. Information about facilities or agencies is provided for each family based on the clinical, financial and geographic needs and preferences stated by the family or client. A Place for Mom does not endorse or recommend any facility or agency as we believe it is the consumer’s sole responsibility to select the appropriate care for a loved one or for oneself. The facilities which are provided are options to assist in finding the right care or housing. Families are encouraged to tour and ask questions of each provider to ensure they select the facility that best meets their needs. A list of questions to assist you in the selection process is available from A Place for Mom, Inc.

Just ask George...

Just spent 30 minutes on the phone with Humana...only 10 minutes per department (apparently that's good?).

According to Humana customer service representative Randy, Keith is over the limit for the year (2009) for medroxyprogesterone, although they admitted that didn't make sense based on last year's needs. That confusion bumped us to the next department. Randy told us he'd fully apprise the rep in Pharmacy Customer Service of the situation so we didn't have to repeat the story. Well, he was sort of right.

While we didn't have to repeat the story, the Pharma Customer Service rep spent most of her time advising us that we should let Medicare know that they had Keith's birthdate wrong on his official paperwork. We assured her that we had done that multiple times and, after her 3rd admonition about it, I cut her off and said we needed to focus on the medication issue. She looked at the records and said, "oh, this is the wrong department, let me connect you to Pharmacy Clinic Customer Service...I'll call ahead so they understand the situation and you don't have to repeat the story."

I knew we must have gotten to some inner sanctum of customer service because the hold music was in the classical vein. George came on the line and smoothly told us that after looking at Keith's records, he had a solution underway. He faxed a request to Keith's doctor and advised us to tell the doctor to elaborate on the medical need for this prescription. Humana would then have an answer in 24-72 hours as to whether Keith could have this medication in the dose the doctor prescribed.

So, perhaps we have a victory in this skirmish. If so, I know that next time I go straight to George...lol.

Subscription does not equal Prescription

I went to Walgreens today to pick up Keith's prescription for Medroxyprogesterone. This Rx is used as a mild, direct stimulant of the respiratory center, thereby improving Keith's breathing. His doctor has directed Keith to take 4 pills 3x/day for a total of 12 pills/day. Keith has been taking this medication for about 10 years and it works well in concert with the other meds he has been prescribed. After all, he's still breathing...lol.

Okay, back to the story. The pharmacy tech told me that the system was not allowing her to fill the prescription for any more than 60 pills...a 5-day supply based on the prescribing doctor's dosage. She got the pharmacist who also tried to override the system to no avail. She called Humana to find out why a standard medication refill was not being honored. She was told that Humana had determined that they would only pay for 2 pills a day, not the prescribed 12 pills/day per the doctor's orders. I was aghast. How does a insurance company with no medical knowledge of the patient arbitrarily change the prescription? I was told they said it was fine for Keith to take the 12 pills/day, but that he'd have to pay for them himself.

The pharmacist at Walgreens said this happens all day, every day. She has sent a fax to Keith's doctor to see if we can get this changed. Next step is contacting Humana Cares...we'll see if they do.

Walter Glendinning, 10.13.31 - 03.14.09

My Dad, Walter Glendinning, passed peacefully at 4am in Corpus Christi from undiagnosed colon cancer. All of us (including Dad) just learned about the cancer on Wednesday so we are grateful that he went swiftly and without pain. He was very well cared for by the medical staff at Christus Spohn Hospital and we will be eternally grateful for the kindness they showed Dad, my sisters and me. I will keep you updated on any memorial service information, which will be in Rockport some time in April.

Dad was born in the tiny town of Hawick, Scotland and found his true home in the even tinier town of Rockport Texas about 20 years ago. Along the way he traveled the world and made many friends over his 77 years. He will be deeply missed by all who had the opportunity to know him and experience his positive energy. He was always ready with a good story, friendly smile, silly pun or joke, and a compassionate heart. He made friends literally to the day he died. There much more to say about Dad, but suffice it to say he had much love and laughter around him.

Thanks so much for all your good wishes and prayers.

Love,

Ruth

If there is a ground zero for both problems, it is Texas

The Healthcare Crisis Hits Home
Karen Tumulty
TIME Magazine cover story

http://www.time.com/time/nation/article/0,8599,1883149-1,00.html

Here's an excerpt that caught my eye...

If there is a ground zero for both problems, it is Texas, where I grew up and where my parents and brothers still live. About 1 in 4 Texans is uninsured, the highest rate in the country. The vast majority of the uninsured — 8 in 10 — live in households in which someone works, typically for a small business. But only 37% of Texas companies with fewer than 50 employees offer medical coverage.

The state's Medicaid program is notoriously stingy. State law requires counties to provide care only to those deemed "indigent," defined as people who earn less than 21% of the federal poverty line, or $2,274 a year for a single adult and $4,630 for a family of four. Many counties, particularly rural ones, do no more than that minimum. So Texas — a state with relatively little regulation of the health-insurance industry — is fertile territory for insurance companies selling bare-bones coverage at low prices.

Read the whole article. It may be better where you are, but not by much. Forward this article to your political representatives. Demand better. You may not need it today, but without a doubt, you will need it soon.