Caregivers Story

Story

I just helped my mother, age 89, deal with her Medicare HMO. Her primary care doctor referred her to a specialist for a nerve conduction study to see if she was a candidate for carpal tunnel surgery. The office staff did not realize that they were required to get prior authorization for that procedure and the HMO denied coverage for the procedure.
My mother got a bill for over $2000. I helped her go through the grievance process to ensure she met the deadlines and used language that would help her case. I argued that the elderly do not fully understand all the fine print in their insurance contracts, and they rely on their primary care doctor to send in the proper forms and get care authorized for them. The HMO reversed its decision and paid the claim.

by: S.

Comments

Be the First to Post a Comment!

QUESTIONS

  • What are rules for Medicaid recipients with regard to the other spouses rights? I'm planning for if I would have to go to a Nursing Home.
  • My father-in-law just got approved for AHCCCS. He had originally signed up for Humana so wondering if he can still use the Humana?
  • My mother's second husband (married 3 years) agrees with my brothers and I that my mother has progressing memory degeneration. We have asked her to get a check up for her own good. Her husband will not help us get her to go for a check up. Is there anything we can do?
  • What is Medicare?
  • My wife is permanatly disabled under social security disablity. Part of her disablitiy is problems with comprehension. Between her learning disablity and hearing impairment, she has a really hard time comunicating with doctors and insurance companies. She just can't comprehend these things. She wants me to be her Medical Power of Attorney so that she doesn't have to deal with insurance companies customer service. The only information I can find is related to seniors. Can you help us? Where to go.. who to see?
  • My mother had quad bypass surgery 10/07. Upon coming home from the hospital we needed a caregiver to help my mom take her meds go to the bathroom , feed herself , bathe herself etc. After 90 days my mothers LTC kicked in. We filed a claim with Humana , which is the provider that administers her medicare , on 04/20/07. We called a couple of weeks later and were told it takes 30 days to process. We then called the end of May and were told they have it but to wait another 30 days. We called at the end of June and were now told it was in the wrong dept but it would now be expedited. I called mid July spoke to a "manager " Joe Clark who said it was still in the worng dept but he wopuld expedite it and call me back in 1-2 days. NO CALL 10 days later I call and speak to Stephanie, and she tells me her sup. will call me back NO CALL. i call 5 days later speak to Woodley , he tells me he has no idea about the delay but will rush it. I call at the end of July speak to yet another manager who tells me they "changed" vendors and need me to refax the entire claim. She asks me what the claim is about I tell her and she tells me that what I described to her is really more "housekeeping" work and not covered. KEEP IN MIND she hasn't even reviewed the claim. I am now approaching 4 months since we first submitted this and I am at wits end. What are my options to get this expedited one way or another
  • I recently moved to Arizona from Oregon. I tried to be seen by a local internist and was refused service without an explanation. I have no conditions which could make me a concern. I asked the office for their evaluation criteria and they would not provide it. If they are going to refuse service, they should at least state the grounds for doing so.
  • how old you have to be before elegibility for medicare
  • Can I utilize financial funding from an established foundation (501(c)(3)) if the INCORPORATOR is placed in a senior living facility due to injury? Upon her discharge, 24 hour care will be required. If yes, how? Thank you.
  • How do I get a list of doctors that participate in the AHCCCS Medical Program in Chandler AZ?

STORIES

  • He told me that I could actually get all the money I needed by using my home as collateral. . .
  • He told me that I could actually get all the money I needed by using my home as collateral. . .
  • He told me that I could actually get all the money I needed by using my home as collateral. . .

LegalLEARN

YOUR FEEDBACK IS NEEDED

  • Welcome to our Newly Redesigned Website! Let us know how we are doing! Please take a couple of minutes to fill out our survey.

FIND LEGAL HELP

  • Please select your county of residence below.

    County:
     

OTHER LEGAL RESOURCES

  • State Bar of Arizona
    www.azbar.org
  • Maricopa County Bar
    www.maricopabar.org
    Referral number 602-257-4434
  • Pima County Bar
    www.pimacountybar.org
    Referral number 520-623-4625
  • National Domestic Violence Hotline
    800-799-7233
  • Bankruptcy Court Self Help Center
    866-553-0893
  • Certified Legal Document Preparer Program
    Link

ORGANIZATIONS