Be Prepared For What You Cannot Even Imagine

Ever have that “Oh, no” moment when you thought you were prepared for anything thrown at you and suddenly you are hit with the totally unexpected, out-of-left-field blindside situation?

My wife Karen and I had it all planned out to the last detail on the day of my daVinci® Robotic Surgery at the USMD Prostate Cancer Center in Arlington, Texas. We were prepared for the surgery and the ensuing recovery period. We had buttoned up our financials and insurance. We’d assumed that our health and/or Long Term Care insurance would cover any contingency for my needs. Okay, wait for it. We never considered the “what if” that we were both disabled and requiring care at the exact same time.

The unexpected...

I lay in my hospital bed recovering from surgery, hooked to monitors, a Foley Catheter to drain my bladder, and lots of painkillers to ease me back into reality. Through the medication fog, I hear “Emergency in the Lobby, Emergency in the Lobby”. A couple of hours later Karen is wheeled into my hospital room with her shattered elbow/arm in a sling, heavily bruised like she got kissed by an air hammer, and drooling from painkillers. What the Fork?

Fast forward to a week later and I’m home with a clear head, dragging a Suprapubic Catheter bag and Karen has her arm in a sling scheduled for elbow surgery. We sure made for a pathetic pair of overly-prepared individuals. Outpatient surgery is clearly a joke for a shattered elbow but I was in no shape to disagree. So, when our neighbor brought her home the evening of my surgery panic poured over me.

Two patients do not equal one caregiver

I asked the surgeon’s office for an order for home care for Karen to no avail. I mistakenly assumed that our Medicare Advantage policy wouldn’t cover home care and/or physical therapy at home so I connected with our Genworth Long Term Care company for help.

They sent a nurse out to do an assessment which recommended all of the needed care, but first we needed to get a doctor’s order and go through our health insurance first. Without the orders I assumed the health insurance would be denied. I was recovering from prostate surgery, assisting Karen in showering, dressing, and cooking. Fortunately Genworth Long Term Care insurance covered housekeeping once a week so that was covered. I did the laundry.

Cracking the care code

Five months later Karen underwent a second surgery on her elbow and shoulder. I was determined to break the code on how this system worked to ensure that Karen received the quality care she needed during her second recovery. Here’s the magic decoder ring.

Ask for a referral to a care agency whether you are outpatient or discharged after a hospital stay. The hospital social worker will refer you to one or two agencies. I did my own research and chose Brightstar Care. I called the franchise owner and found out that they will run all of the traps for getting the health insurance approved, an assessment and get the physical/occupational therapist assigned in Karen’s case.

Note: Medicare Advantage plans have no copay or out of pocket charges for skilled and home aids, or the physical therapist (with doctor’s order).

My big take aways:

  1. Review your health insurance coverage and Medicare guide. Call the plan customer service for any questions.
  2. If you own Long Term Care Insurance get them involved right away if your insurance company won’t cover your used your maximum benefits. To avoid out of pocket expenses where you are reimbursed by the long term care provider assign the benefits to the agency you are working with. This won’t apply if you are using independent agents or individuals. In this case, it is on a reimbursement basis.
  3. Ask the discharge nurse to get the hospital social worker assigned to get the orders faxed over to the agency you choose or their referral. (If you leave it up to the hospital you’ll be fielding calls from several agencies which is annoying).
  4. Complete all agency documents so that they can get health insurance approval.
  5. Stay on top of the process to ensure that care is implemented in a timely matter. It’s a daily follow up even if only by email.

I share this with you so that you will “Be Prepared” in the event of a joint catastrophe in the future.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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