March 10th, 2008
My father only had a couple thousand dollars of life insurance in force by the time he turned 83. He outlived the term of one policy, so the insurance company paid him the cash value and terminated the policy.
As someone who was deeply affected by the Depression, Dad would probably have jumped at the chance to sell a life insurance policy for more than the cash value. But, as someone in the early stages of dementia, he was vulnerable to being swindled. We had one close call with his investments.
I want to alert you to the booming business in life settlements that is still largely unregulated.
Help for the Terminally Ill
It started out as a compassionate way to help someone who has large medical bills to pay. It’s called a viatical settlement. It gives a person, typically with less than two years to live, who owns a large cash value life insurance policy but does not have a spouse or children, a way to get cash out of the policy.
Cash value insurance policies (also called whole life) have provisions for the owner to cancel the policy and receive the “surrender value”. But, this amount is usually very small compared to the total amount of insurance. The settlement company is usually willing to pay much more. The viatical settlement became popular during the 1980’s as a way to help terminally ill AIDS patients deal with the high cost of medical care.
A New Investment is Born
The purchased insurance policies from those early viatical settlements were sold to individual investors. Because this new investment was unregulated, it attracted some unscrupulous dealers. Salesmen were paid high commissions to sell the policies to investors who did not always understand what they were buying. The investment community soured on buying settlements.
In 2001, the National Association of Insurance Commissioners released the Viatical Settlements Model Act which established guidelines for ensuring sound business practices and avoiding fraud. It was about that same time that settlement dealers began purchasing policies using institutional capital. The demand for settlements as an investment began to increase.
Better Than Mortgages?
From an investor’s standpoint, buying insurance policies is even better than buying mortgages. Everyone dies! As long as the insurance policy was written by a company that is solid, the investor gets paid.
Investing in mortgages, once considered much safer than stocks or bonds, is not as predictable. People can get sick or disabled, lose there jobs, or have other life events that prevent them from paying the mortgage. US economic problems today were caused in part by defaults on mortgages — many made by unscrupulous brokers who bent the rules.
Most mortgages today are combined into packages that re-sold to large institutional investors. It wasn’t long before some enterprising folks figured out that they could package these purchased policies, now called life settlements, and sell them to institutional investors for generous commissions.
Easy To Be Taken In By Easy Money
It happened to Larry King, CNN’s famous talk show host. King alleges in a lawsuit filed recently that he was the victim of a scam to buy and sell life insurance on himself, also called “flipping” policies. While King made $1.4 million on the deals, he now realizes that he would have been better off if he had kept the policies. He feels that he was cheated.
An insurance company owns the $15 million in policies, a company by the name of Coventry Insurance. Coventry was sued last year by the State of New York for alleged predatory practices.
Yesterday, our local newspaper, the San Jose Mercury News, reported that flyers were circulating at a San Luis Obispo, California senior center telling seniors they could get as much as $50,000 from “investors that want to speculate on our life expectancy.”
Although the NAIC issued the Viatical Settlements Model Act in 2001 and amended it in 2007 to strengthen consumer protections for “Stranger- Originated Life Insurance” only 35 states have officially adopted the guidelines. California, where I live, has not yet adopted any guidelines.
What’s The Harm?
If Larry King, who is a reasonably intelligent 73 year old, could be duped, anyone could be. Particularly someone in the early stages of dementia.
Life insurance is just one part of a total financial plan. Selling a life insurance policy really needs to be evaluated in terms of the person’s overall needs and financial status. These life settlement companies are not doing that.
So we caregivers need to be alert to these issues. If your parent tells you about a wonderful opportunity to sell an old life insurance policy, get to the financial planner or attorney to have the deal reviewed right away. Who is buying the policy? Will it be sold to a third party? Who is that?
The Mercury News article quoted Jay Adkisson, an attorney who writes a blog about financial fraud, “You ought to know who you are selling to. You don’t want Tony Soprano buying your life insurance policy.”
Good advice.
March 10th, 2008
February 29th, 2008
Sorry, Eric (Schmidt, CEO of Google).
Google doesn’t belong in the health records business.
For those of you who don’t follow Google’s business on a daily basis, here is a brief rundown of what has happened.
Last year, Microsoft announced a new service called Health Vault to help individuals manage health records online. This is not a revolutionary idea. There are already several smaller companies on the Internet offering individuals the convenience of storing health records online so that they are more available when they are needed. Several of the large players in the business of providing technology to doctors offices and medical clinics also have digital records initiatives.
But, no one company has been able to gain serious momentum in digital health records. It is a gargantuan task to coordinate doctors, labs, hospitals, pharmacies, insurance companies and individuals AND meet all of the requirements of HIPAA for privacy. Microsoft has already collected an impressive number of partners to work with Health Vault.
Google Announcement Starts Tsunami
In Orlando, Florida last week, Google announced Google Health, a platform for individuals to manage medical records such as medical test results and prescriptions. The announcement set off a wave of protests from consumer privacy advocates. Eric Schmidt is trying to soothe the uproar by saying that Google won’t sell ads on Google Health.
Oh really?
Here’s how one analyst sees the situation:
“Gene Munster, an analyst at Piper Jaffray, firmly believes ads will happen. ‘Advertisers would pay absurd amounts of money to be seen when someone wants to, say, refill a subscription online,’ he says.’ This is more lucrative than commerce-related search.” For the complete story, click here to see Jefferson Graham’s article in USA Today.
Digital Records Could Save Lives
I’m not a Luddite. I work for a company that develops mobile technology.
And, I have had to fight ferociously with doctor’s office administrators to obtain my Dad’s medical records as well as my own and my children’s records. In one case, I had to pay $100 for a file of poor photocopies that I could barely read. Forget about scanning to digitize them.
My father was caught in the bind between doctor and hospital. His regular family doctor had all of his records but she wasn’t admitted to practice at the hospital closest to my father’s home. The hospital would “assign” him a doctor while he was there. But the records never made it back to the family doctor.
The cardiologist at the hospital might not have put my father on Plavix if the doctor knew my father had a history of gastrointestinal bleeding. At one point, the docs who did not talk to each other had my father on DOUBLE doses of 4 different medications. It only got corrected because he could feel that the medications were not working right. He went to the family doctor who reduced all the doses and got rid of the duplicate medications.
That was a close call! And, it is a safe bet that this happens to thousands of Americans everyday.
If you have experienced anything like this, you may think I am crazy to oppose help from the two tech companies that have the best chance of making digital records happen. Pam Dixon, executive director of the non-profit World Privacy Forum, said it best,”A publicly traded company is supposed to have shareholders (my emphasis) in mind first.” (As quoted in an Associated Press article by Travis Reed.)
The Push for Quarterly Profits
Wall Street, institutional and individual shareholders are illogically relentless in their push for quarterly profits from publicly traded companies. Every employee knows what ROSHE (Return on Shareholder Equity) its company is trying to achieve. The focus may be making customers happy so they buy more product or service but the goal is always ROSHE.
The bulk of Google’s revenue comes from selling ads. Microsoft sells software and services. These companies are locked in a battle to gain your attention for its products and partners’ products. Each is working to dominate the marketplace.
So, it is easy to envision a scenario in which our personal privacy gets compromised.
But, it doesn’t have to be that way.
Microsoft has the platforms to connect little devices like a glucose monitor to your home computer but its web sites infrastructure is not as strong as Google’s. (Full disclosure– my company is a Microsoft Partner. I have many good things to say about Microsoft but not when it comes to its web sites.)
Google has the digital infrastructure to power web-based communications around our planet. If you use Google to search the Internet, you are tapping into an amazing, gigantic, distributed network that gives you search results after it has filtered out over 3 million malicious or problematic web sites in a small fraction of a second. But, even Google admits that its first version of a G-Phone is buggy beyond belief.
I admire both companies for what they have achieved and the vision they espouse. But both companies have the compelling need to make ROSHE. Right now Google has advertisers that are willing to pay $25, $50 or more when a person visits the advertiser’s web site. The possibilities for enormous revenue for delivering pharmaceutical ads, for example, to consumers are easy to imagine. Google has all of the technology from Double Click to track every purchase you make. It’s only a short step to your entire medical file.
Microsoft has slightly different, yet just has huge revenue possibilities. It’s making the Wall Street analysts giddy with thoughts of double digit quarterly profits.
The Third Alternative — A Consortium
It’s hard to get things done by committee. Compromises can result in gazelles that look more like camels. But sometimes a non-profit organization or a governmental entity is the only way to protect citizens from the fallout of the giant corporate gladiators.
From my vantage point, the only way to assure that digital health care information does not become another series of battles like Blu-Ray versus HD-DVD (or Betamax vs. VHS for those who have long memories) is to have a non-profit consortium responsible to citizens to safeguard privacy and set standards for interoperability.
Think of the headaches if you want to change doctors but the new doctor doesn’t use the same medical records system. If you choose to go with the new doctor, you have to figure out a way to get all of the pertinent data into the new system. That’s more time out of your week, more money out of your pocket, and another point where your information could be corrupted or misused.
Now is the time for Microsoft and Google to call a truce and become part of a non-profit consortium for health care records. It won’t be perfect, but when consumers trust that their information is safe, they will sign up to buy in droves. And that would make Wall Street happy, too.
February 29th, 2008
February 14th, 2008
And, Make Sure to Have Pudding for Dessert
What?!
A popular nutrition newsletter arrived in my email today talking about Vitamin D deficiency in the US. I was surprised to read that Vitamin D deficiency is very common in the US. A recent study in the American Journal of Clinical Nutrition (January 2008) found that a low blood concentration of Vitamin D was associated with higher blood pressure in Caucasians (but not African Americans.)
It seems that researchers are finding all sorts of health issues that a little bit more vitamin D would lessen or prevent. Most important for seniors — Vitamin D helps your body use calcium to build stronger bones.
Hip or other bone fractures are often the beginning of a grindingly slow downward spiral for many seniors. Less mobility leads to even less mobility. The end of the line is the nursing home.
The crying shame is that Vitamin D is so easy to get through our diet, supplements and sunlight. Eggs, tuna, salmon, mackerel and sardines are good sources of Vitamin D along with fortified milk products.
Your daily vitamin probably contains it, but not enough. The recommended daily allowance is 400 IUs. Many all in one supplements contain less than half that amount.
More Is Better
Dr. Andrew Weil, (click here) highly respected for his approach to combining nutrition with traditional medicine, recommends 1000 IUs per day and even more if you don’t get out in the sun at all. His recommendation comes after extensive research into the latest studies on Vitamin D.
His conclusion: More is Better!
Love the One You’re With
Here’s an easy way to show your Valentine you care. Take your parent (or loved one) out for a walk in the sunshine, weather permitting. Just 15-20 minutes of sun on your hands and face is enough. But, don’t put on sunscreen. It blocks your body’s ability to make Vitamin D. Take the sunscreen with you to apply after you get a bit of sun if you’ll be out more than 20 minutes.
Then, have a lovely salmon dinner. Tuna sandwiches are ok, too (go light on the mayo.)
And, top it off with pudding made with fortified milk (nondairy, if milk is a problem). Sorry, milk chocolate truffles don’t count.
Both People Benefit
Spending time with someone to celebrate has benefits for your parent, loved one and you. Mind, body and spirit. Don’t miss out.
February 14th, 2008
February 9th, 2008
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February 9th, 2008
January 30th, 2008
A Good Friend Remembered
A good friend of ours died the third week of December. We just received a note from his daughter responding to our holiday card. Unfortunately, it never reached him.
We sent cards every year even though we were never quite sure our friend could read the card. AG, now in his 60’s, had worked with my husband some years ago. Macular degeneration wiped out his sight, and his ability to make a living as a computer programmer.
His vision problems were already underway when he attended our wedding 20 years ago. He soldiered on, working from home and adapting his life to his condition.
When his vision decreased to the point that he could not drive, he rode his bicycle for shopping and errands. AG amazed me with insistence on doing things for himself. He was determined to maintain his independence. Eventually, even bicycle riding became impossible.
Women Are More At Risk
While it’s true that women are more at risk of developing macular degeneration than men, AG had two other high risk factors working against him: smoking and high blood pressure. And, based on what we know about his cooking and eating habits, nutritional deficiency was a distinct possibility.
You are also more likely to develop AMD if you are over 60, have a family member who has it, are seriously overweight, have other cardiovasular problems, have light eyes and spend a lot of time in bright sunlight. Whew! We fit in several of those categories. That’s scary.
Five Easy Steps to Healthy Eyes
Fortunately, there are some very easy things you can do right now, no matter what your age is, to prevent Age Related Macular Degeneration from happening to you.
- Stop smoking. Not only will you reduce your risk of AMD, you will reduce your risk for a long, long list of health issues. If you still smoke, you know what I am talking about. My annual bout of bronchitis mysteriously disappeared after I quit smoking.
- Eat a colorful, balanced diet. Leafy greens, bright colored fruits and vegetables, eggs, lamb, poultry, fish, nuts and seeds and whole grains contain antioxidants, vitamins and minerals that nourish our eyes. The key nutrients are Vitamins A, C, E, Zinc, Selenium, Lycopene, Beta-Carotene, Lutein and its cousin, Zeaxanthin. A recent study found that one egg a day substantially increased the amount of lutein in the bloodstream of post menopausal women in the study with only a very modest increase in cholesterol. Can’t eat that much? Supplements can help, too. Here is a link to the Mayo Clinic’s complete list of supplements for the eyes.
- Stop eating processed baked goods. Put down that danish and slowly back away from the table! Ditto for cookies, cakes, crackers and chips. There is evidence that hydrogenated fats double your risk of progressing to advanced stages of AMD. And they are terrible for your cardiovascular system. As an added bonus, you may find that you have an easier time with your weight and more stable blood sugar. My sugar highs and lows are gone. (Yes, I do miss a gooey cinnamon bun every now and then.)
- Wear sunglasses that block UVA, UVB and blue light. Do you remember the “BluBlocker” sunglasses ads on TV a few years back? I thought it was just slick marketing. It turns out that yellow or amber tinted glasses block blue light and really do reduce glare so that you see more clearly. Blue light is believed to react with the pigments in the retina to produce free radicals causing waste products to build up in the retina if not cleared out by antioxidants. The studies are mixed on whether blue light causes macular degeneration. It may be that people with light eyes have less protection because there is less pigment in their eyes to block those wavelengths. It makes sense to me to wear UV/Blue blocking sunglasses while out in bright sunlight since UV has been associated with the development of cataracts. Not long ago I bought a pair of sunglasses that were gray instead of amber. I really notice the increased glare compared to my old pair of amber sunglasses. I’m switching back to amber.
- Get regular eye exams. If you are over the age of 40, seeing your eye doctor every two to four years is recommended. Over 60 years old, the recommendation for eye doctor visits is every one or two years. (More if you have problems.) There are several tests that the doctor can use to check the health of your retina and the macula (the small part of the retina responsible for clear vision.) If your doctor offers Optomap, make sure to get it. The Optomap is a computerized camera that takes a wide angle picture of the retina. It allows your doctor to get a really good view. It doesn’t require dilating your eyes with drops so that you have trouble seeing for several hours. Because the digital image of your retina is stored in the eye doctor’s computer, he can compare older images with the newest ones to look for changes - much better than working from notes in your chart. With early detection, you can take steps to stop the progression of AMD . . . and keep your sight.
January 30th, 2008
December 13th, 2007
Dad rarely travelled outside of a 10 mile radius of his home. The one or two times each year that he needed to go farther, he would enlist someone to drive with him. So, I never pressed the issue of getting a cell phone for emergencies.
When I showed him my newest phone, he dismissed it saying,” The buttons are too small. I can’t read that screen. I’m hard of hearing, you know!”
Then came the accident.
Dad was driving back from the car dealership, took a wrong turn onto the New Jersey Turnpike, got lost and tried to find his way back through a neighborhood he had never seen before. Peering sideways to read the street signs, he veered into a parked car. Crash!!
My father was a very lucky man. The owners of the parked car were looking out their kitchen window when it happened. They rushed to help him.
He climbed out of his car, shaken, but not injured. At first, the police thought he was drunk. When my father told the police he was a diabetic and could not drink, they worried that his blood sugar was too low.
Eventually, Dad convinced them that he didn’t need an ambulance, just someone to take care of his car and give him a ride home. Those good samaritans who witnessed the accident called someone to take care of the car. The car repairman took my Dad home.
My father waited for several days before telling me about the accident. He knew before I said a word that I would urge him to give up driving. He did stop driving shortly after that incident. It had scared him that much!
It scared me, too. What if nobody had been around to help?
I wish that my Dad had had a Jitterbug phone.
Jitterbug cell phones are designed to be easy to use with big, back-lit buttons, large text, and a powerful speaker for loud, clear conversations.
What makes the Jitterbug phone perfect for seniors is the live, 24 hour operator service. The operators will make calls for you, assist you with finding a phone number from a directory or add names to your phone list. (5 minutes are deducted from your minutes for each operator assist.)
The best part is there are no contracts and no long distance roaming fees. You choose the plan that’s right for you (as low as $10 per month.) You can even share minutes with another family member.
If your parent likes to go out and about but you worry, get your parent this phone for the holidays or any gift giving occasion. The price of the phone is very modest – $147. The peace of mind for a caregiver is priceless.
To learn more about the Jitterbug phone and service plans, click here.
photo courtesy of GreatCall, Inc.
December 13th, 2007
November 30th, 2007
Our local newspaper added a ton of heat to the controversy that rages this time of year about which college a high school senior should attend. The headline read: Forget the Ivy League: Most Valley CEOs Went Public.
Right now, high school seniors everywhere are polishing essays to impress those soon-to-be bleary eyed college admissions staff, many of whom will read more essays than ever before. Our children born in 1989 (4 million babies born) and 1990 (4.2 million babies born) are part of a boomlet almost as large as the late baby-boom year of 1961 when 4.3 million babies were born.
Consequently, colleges are seeing more applications than previously and turning down top candidates they would have welcomed just a few years ago. Admissions directors expect this to continue until the end of the decade.
Ever resourceful and upbeat, many high school guidance counselors are countering with the mantra, ” It doesn’t matter where you go to college. A top student can succeed anywhere.”
The MercuryNews article by Mark Schwanhausser seems to support that, too. The statistics on Silicon Valley CEOs does show that the majority attended public universities. Most have two or three degrees, though, with an MBA and/or a Ph.D in engineering being the most common.
The CEOs who were interviewed for the newspaper article often remarked that they chose their schools for reasons other than getting to the top of the corporate ladder. But, then the author threw parents everywhere a curve ball.
He asked recruiters for Cisco and Intel where they look for college graduates when they recruit for jobs. Both recruiters readily admitted that they do their searching at 30 to 40 of the “absolutely best schools in the United States.” Companies know that the tough screening process at certain schools makes their job easier. This quote from one recruiter is highly revealing,”Finding great talent at other schools is possible, but it takes more work.”
So if you want to work for one of the best technology companies, you’ll have an easier time getting an interview if you go to one of the “top schools” because recruiters focus their efforts there.
You can find a ranking of the top schools from US News and World Report. But, you’ll need to pay $14.95 for the premium online edition to see all of the ratings for all of the colleges. Another resource is the CollegeBoard.com. In addition to overseeing the SATs, the CollegeBoard has expanded into college planning, college search and college financing (beware of the sales pitches here.)
But, you may be asking, what about Steve Jobs and Larry Ellison? They both dropped out of college and are doing just fine. Does anyone really need college at all? Why not just get started on building up job experience? How the heck do you advise your son or daughter when they ask for your ideas about this?
Here’s my take on it: Attending college is an incredible opportunity to study something that interests you and to sample topics you haven’t tried before. (Steve Jobs credits a calligraphy class with igniting his sense for design.) Most careers today require at least a college degree. If you don’t have one, at some point you get passed over for promotions. Your teen should plan on a graduate degree if he/she has aspirations to climb the ladder of success in technology.
I believe that it is important to find the best ranking school with the best fit for your student’s needs. Definitely look at public schools but don’t ignore private colleges and universities because of cost. See my post on financial aid.
By the way, Larry Ellison of Oracle and Steve Jobs of Apple are both wildly successful without college degrees because both started their own companies and led them to major success. No one asks to see their diplomas. They have proven they can produce results.
But, a new college graduate will be measured by the name of the school on the diploma. America’s top corporations will all vie to hire from the so called top 40 or 50 schools. So, the answer is yes. It does matter early in their careers if they dream of sitting at a desk at any of the Fortune 500.
Ultimately, anyone can succeed with a willingness to work. My favorite no BS book on the subject is:Automatic Wealth for Grads . . . and Anyone Else Starting Out
Michael Masterson may not be as well known as Bill Gates but offers solid tips from his real life experiences working for others and owning his own companies. This former Peace Corp volunteer and college professor has insights that are right on target. You may even want to check it out for yourself. I did and learned a lot!
November 30th, 2007
November 26th, 2007
The mood was relaxed and happy on the five hour flight from California to New Jersey. It was Thanksgiving Day. The sun was just beginning to set on what must have been an unseasonably warm day on the East Coast. I smiled to myself. The plane had arrived ahead of schedule. I would be at my father’s home in time for dinner with him.
The airport shuttle driver let me off outside the patio of my Dad’s place. I could see Dad was sitting motionless in his recliner in the corner of the room. Only the kitchen light was on, but I could easily peer into this tiny garden apartment in an independent senior living community. It had been my father’s comfortable home for the past year.
The TV was off. Dad must have fallen asleep, again.
I knocked on the glass patio door and eventually woke him from his nap. He was overjoyed to see me. But, his mood went from gleeful to glum in only a minute. “I’m sorry. I’m afraid I don’t have dinner for you,” he said.
In our phone conversations over the past few days, my father had chatted cheerfully about preparing his favorite dish, baked turkey legs, for us for Thanksgiving. He had discovered a great recipe by accident and wanted to share it with me.
“I guess I fell asleep and didn’t hear the timer,” he continued. “ The turkey legs were totally burnt even though I had them in a low, 250 degree oven.”
“How long do you think you overslept?” I asked.
“Oh, it might have been six hours,” Dad said sheepishly.
“That’s ok. You have some hamburgers in the freezer that we can make, right?” I said trying to sound upbeat. (Did I hear that right, six hours?)
I walked into the kitchen to start preparing the hamburgers. The stove was dirty. Pots had boiled over and burnt remains littered the trays under the burners. I peered into the oven. It was just as dirty. The entire apartment smelled like burnt food. This was a major change since my last visit.
I tried to hide my uneasiness as the realization began dawning on me that Dad was not able to safely cook for himself anymore.
“Gee, Dad, it looks like you had a few pots spill over,” I said.
“Yeah, pots boil over from time to time. It’s no big deal,” he growled.
“Looks like you could use some help with the cleaning, Dad. ”
“I’m doing fine by myself! I don’t have extra money pay for cleaners. I have barely enough to live on! ” Dad’s growl had turned into a shout.
Lowering my voice, I turned to him with a big smile, “I know you have done a really great job managing your money. It is looking like you could use a little help here, that’s all.”
That was the beginning of a weekend-long argument. I gave my father all sorts of suggestions for ways he could get help. He rejected every one.
We met with a non-medical in home care provider. Dad turned pale when he heard the hourly rate. I got out the rate sheet for the additional cleaning services that the senior apartment complex offered.
“That’s too much! Dad shouted.
Finally, I hit upon the idea of Dad purchasing the meal plan from the dining room. Together, we figured out how much he spent on food. It looked like buying dinner on the meal plan would not cost much more than he was already spending.
I reasoned and cajoled. Dad finally agreed that he would enjoy getting his evening meal from the dining room. All that was left to do was for my father to sign up for the plan on Monday. He said he would do it.
I left for the airport on Sunday evening with a light heart.
On Monday, I phoned to remind him to sign up for the meal plan. He began to waffle. Maybe he would wait until December. Maybe he would wait until he finished the food in the freezer. Maybe he would wait until . . .
Of course, I knew these were just excuses. For each one, I countered with a reasonable argument. Dad thought up another. He wasn’t going to do it and I was too far away to exert the same kind of influence I had when I was physically there.
A November 2007 study by the National Alliance for Caregiving and Evercare found that the long distance caregivers spend an average of $8728 per year out of their own pockets to help an elderly family member. Local caregivers spend somewhat less — approximately $5000 annually.
And, it is no surprise to me that the largest percentage of this expense is going to provide care attendants, followed closely by medical expenses and long distance travel. I had already been spending money for travel to see my Dad. Once your parent needs care, but cannot or will not pay for help, the family may need to provide it. Those of us who work are forced to rely on paid helpers to to assist with eldercare. Bu, this can have a negative financial impact on the family members paying for care.
Fate took a different turn with my father. Later that week, he developed a nose bleed that the nurses at the retirement community could not stop. His trip to the hospital ended up lasting over three months.
The nurses also reported to the managers that Dad was having trouble keeping up the apartment. The managers said they would refuse to allow him back into his apartment when he was released from the hospital for his own safety.
Now instead of convincing him to eat in the dining room, I had to convince him to move to the next level of care. To be continued . . .
November 26th, 2007
November 20th, 2007
What’s all the fuss about the Medicare Prescription Drug Program?
Open enrollment started on November 15th and runs to December 31st. This is the time when anyone can change from one plan to another without paying a premium penalty. If your parent is already enrolled in a program, you may be wondering why you need to worry about this.
Medicare and health care advocates in every state are trying to get the word out that the rates are changing. There are major rate increases coming to the most subscribed plans, while some of the smaller plans are decreasing rates. Here in California rates in some plans are increasing by 31%.
All seniors should reevaluate their Medicare Drug plans to see if it still makes sense to stay where they are. They can check Medicare’s website for help with choosing a plan that covers the specific prescriptions that they need at a cost they can afford. It is important to do it now before the enrollment period ends.
Can there really be that much of a difference?
Yes.
This year doing nothing could be very expensive for your parent. Monthly premiums could increase substantially. Or, you may discover that required medications are not covered by your plan.
And, of course, there is the highly confusing problem of the “donut hole.” I don’t know who invented this “cute” name but it is a gap in coverage that can take a lot out of your pocketbook. Here’s how it works:
You enroll in a plan and pay a monthly premium. You pay for your prescriptions until the deductible is reached. Once you have met the deductible of $265, the basic prescription drug plan will pay 75% of your drug costs and you will pay the remaining 25% until your total drug costs reach $2,400.
Then, you are responsible for 100% of your drug costs between $2,401 and $5,451.25. This gap in coverage, the “donut hole”, requires that you pay $3050.25 out of your own pocket before Medicare pays any more for you.
While this is happening, you are still paying your monthly premium. If you get to December 31st without going past $5451.25 prescription costs, there is no additional help. You start the new year meeting the deductible again.
Once your total drug costs reach $5,451.25, the basic prescription drug plan will pay 95% of your additional prescription costs and you will pay up to 5% (or a small co-payment) of your remaining drug costs for the rest of the calendar year.
Each insurance company that offers Medicare Drug coverage has the option to add benefits. Each company can also determine which drug they will or won’t cover. Some companies will pay for certain generic drugs during the coverage gap while others pay nothing.
There are so many plans, with different options, that vary from state to state, that you need to evaluate before you sign up. It’s just plain confusing!
Fortunately, every state has Health Insurance Counseling and Assistance Programs. You can find someone in your area to provide free counseling about the plans that would be right for you. You can attend workshops on choosing the best plan.
Before you contact the Health Insurance Counseling and Assistance Program in your area, it’s a good idea to figure out your total drug costs for the past year and make a list of your regular prescriptions so you can compare it with the list of approved drugs for each plan.
It’s work to do this, I know. It is so tempting to just stay with the plan your parent already has.
Don’t do it! Make time now for your parent (or yourself) to find the best plan that is available. You’ll be glad you did.
November 20th, 2007
November 9th, 2007
It wasn’t until Dad mailed me the collection notice that I realized he was losing his ability to track and pay his medical bills. He had complained during our phone chats on several occasions that the hospital had messed up his billing. They kept phoning him to get him to pay his bill.
He insisted that he had paid the bill– $124.34. The hospital billing staff asked him to send a copy of the cancelled check. But, Dad adamantly refused to go through the work of getting the cancelled check. It was the hospital’s mistake for losing the payment.
I was dumbfounded by his vehement refusal to deal with a straightforward problem. Ironically, in his younger days, my father had been a stickler for financial details. As a young adult, I would have gotten a scalding rebuke for failing to take action on something like this.
His unusual behavior was a warning that his dementia was beginning to impair his judgement, while his anemia left him so fatigued that even a trip to the bank seemed like an overwhelming task. I didn’t recognize it for what it was. I thought he was just being obstinate.
Being 3000 miles away, I tried to get my father to read his checkbook to tell me the check number for that hospital bill. Then, I went online to see if that check had cleared. The check number he gave me had been cashed but it wasn’t anywhere near the correct amount for the bill. I looked for another check with the amount $124.34. I didn’t see any in that month that matched.
I told my father that the only thing to do was pay the bill. He refused. No amount of reasoning worked. So I made a deal with him — I would pay the bill and he would reimburse me.
Grudgingly, he agreed.
My father had already signed a power of attorney giving me the authority to handle his finances and one for health care, too. So, I began learning first hand about Medicare, supplemental heath coverage and prescription drug benefits.
Dad had to sign a form to allow me to access his online medical insurance claims and to speak for him to the insurance representatives. I left instructions for them to phone me first since Dad’s hearing was poor.
I paid the bill. Dad eventually reimbursed me. The collection notices and phone calls stopped.
It wasn’t until a couple of months after my father’s death that I found the entry in his checkbook. Dad was right all along. He had paid the hospital within days of receiving the bill. But, he was so certain he remembered the correct check number that he never looked it up. I was too far away at that time to double check it myself.
The story doesn’t end there.
Another billing mistake almost happened today. I started to pay a doctor’s bill for my father’s estate and discovered that it was more than it should have been.
The doctor is supposed to bill Medicare first. After Medicare determines what it will pay, the doctor sends the bill to the supplemental insurance.
Only after the supplemental insuror has completed the claim, should the doctor bill the patient for any balance due. But this latest bill didn’t show any payment from the supplemental insurance, so I checked the online claims information.
The supplemental insuror had rejected the claim because documentation was missing. Well, sometimes paperwork does get lost. You need to follow up to get another copy sent.
I called and spoke to the medical billing person in the doctor’s office. She pulled up the records on her computer. She stated that my father owed this amount of money. I asked if she sent it to the supplemental carrier.
She said, “Yes.” And promptly read my father’s account number for the insurance.
I asked her, “Why do the online records say your claim was rejected for lack of documentation? The amount you are billing doesn’t appear to include any payment from the supplemental insurance.”
People do make mistakes (including me). Where there is an honest mistake, you can hear the surprise in the person’s voice. “How did that happen?” Sometimes, they laugh self consciously.
There was no surprise in this woman’s voice. There was no admission of a mistake. “We understand your concern . . . we will make sure it gets handled.” She was billing my Dad for the entire amount rather than resubmit the bill to the insuror with the information that was needed. Efficient but totally lacking in ethics.
I wish I could say this was the only mistake I have found. Unfortunately, billing mistakes have happened so many times in the past 9 months of settling my father’s estate.
How many elderly patients pay too much because they don’t have the patience or focus to follow up?
If you have been wondering how you can help your aging parents, discuss helping them with tracking medical bills. Have your parents collect everything (bills, medicare statements, supplemental insurance statements) in a folder. Set up online access to insurance if its available. Make a regular date to go over the bills each month before anyone writes checks.
You may need to make phone calls for your parents. Be aware that privacy rules prevent the insurors from talking with you about your parents’ account unless your parents have given permission in writing.
You’ll be providing peace of mind and possibly saving money for your parents, too.
November 9th, 2007
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