Unfortunately, the vendors of these policies use almost every weapon in their arsenal to avoid paying benefits.  In the past year, I have been working with a family who bought long-term care insurance coverage for both husband and wife many years ago.  They had been paying the monthly premiums regularly.  By the time they needed to trigger the policy for their care needs, they had paid over $100,000 in premiums.

One would expect that the insurance carrier, having been paid so much money, would make it easy for this family and the care providers to obtain the benefits.  Sadly, the opposite was true.

For example, invoices from the in-home care agency were mysteriously “lost.” Multiple times.  The two fax machines that are designated to receive the invoices are over-worked and frequently out of service.  The processing times are so long that it takes months before we can determine if an invoice has even been received.  The ability of Customer Service to actually help solve a problem is inconsistent at best.

I have been told by my client’s in-home care provider that this is not unique to my client, or to their insurance carrier.  This provider has the same problems with most of the carriers, for most of her clients.

Why do insurance providers make it so difficult to navigate their systems to collect the benefits for which consumers have already paid thousands of dollars?

Basically, insurance is about gambling.  The insurance companies gamble that they can take in more money in premiums than they pay out in benefits.  They put low-cost systems in place that make it more challenging for their policy-holders to track and receive all the payments for which they are eligible.

In the case of my clients, the wife passed away mere months after beginning to receive benefits.  By rough calculations, the insurance company collected $60,000 more than they paid out on her case.  In reality, it took months of repeated faxes, phone calls and escalations to managers to actually generate the payments that were finally made.

Thousands of policy-holders do not have the time, mental acuity or energy to persist in their efforts to force the insurance carriers to pay up.  So the most vulnerable – sick, elderly people – are, once again, taken advantage of by the companies that are entrusted with their financial care.  Why are we not surprised?

Become a smart consumer.  For more information, you can download a free brochure from the Society of Certified Senior Advisors as well as other excellent resources in their public library.

Submitted by Debora Harvey, Patient Navigator LLC

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Now imagine trying to face all this when you are grieving the loss of a loved one.

It is very hard.  It is painful.  It is unbearably sad.

I lost my mother very suddenly and unexpectedly in May 1990, when she was 63 and I was 31.  I made the decision to skip Christmas entirely that year – no tree, no gifts, no decorations.  I simply could not bear it.  Fortunately, my boyfriend (now husband) understood and supported me, and there were no children to worry about back then. It was the best I could do.

The pressure to go along with the holidays is intense.  Here are my own tips on how to get through them if you are grieving.

1.  Don’t let anyone pressure you or try to tell you what will make you feel better.  Only you know what helps.

2.  Remember your loved one in whatever way seems right – a walk in the woods, a prayer service, watching their favorite movie, setting a place at your table.  You don’t need anyone’s permission or concurrence.

3.  Don’t be afraid to tell people that it really is not a Merry Christmas or Happy Holiday for you.  Let your colleagues at work know that the season is hard for you and ask them to understand if you are distant.

4.  Learn to say no.

5.  Give yourself permission to mourn.  It is normal and necessary.  And then tell yourself gently, over and over, that you will not always feel this way.  And, in time, you won’t.

I’ve learned a great deal over the years about loss and grief.  I’ve learned to grow from each loss in my life, but it has taken a lot of work and faith.  If you are grieving this holiday season, you are not alone.  But please know and believe, with all your heart, that you will not always feel the way you do now.  Time does heal.  Things will get better.

For more information on grief and the holidays, I suggest:

Therese A. Rando, PhD.  Grieving:  How to Go on Living When Someone You Love Dies. (Note:  This book saved me as I grieved the loss of my mother).

Elaine Tiller, M.Div.  When Grief Comes Home for the Holidays, How do you Manage?

Capital Hospice.  Good Mourning: A Resource for Healing.

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Traditional Medicare Part A covers hospitalization, skilled nursing facilities, some home health and hospice. Part B covers physician and outpatient services and requires a monthly premium. Under the new health care law, Medicare will now pay 100 percent of the cost of annual physicals and other kinds of preventive health care, such as cholesterol and obsesity screening.

At this time of year, beware of slick advertising directed at your seniors from Medicare Advantage programs. These Medicare Advantage (Part C) programs are HMOs run by private insurers and carry the same pitfalls as standard HMO plans. They seek to lure seniors out of traditional Medicare with promises of extra benefits. Don’t be fooled. These insurers impose more restrictions on the doctors you can see and the benefits you can receive. The extra benefits they advertise, such as dental and vision care, will be phased out as the government cuts back the subsidies it pays to Advantage plans.

Medicare Part D drug benefits are an important component and require some work to find the right plan. Fortunately, there are excellent tools available tools to help you. The starting point is to develop your list of prescription medications. The variables to consider are brand vs. generic drugs, whether it makes sense to have a lower monthly premium and a higher deductible or vice-versa, the plan’s formulary and authorization requirements, and the plan’s cost.  A great place to start is through the government Medicare site’s Resource locator. You can create a drug list and use it to begin your search.  There is a wide price range among the private insurance companies that offer Part D plans.  The right match for your senior’s medication needs can save thousands of dollars a year.

The final component of your senior’s Medicare coverage is probably a Medigap supplement plan. Medigap is designed to fill the gaps in original Medicare coverage, such as deductibles, co-insurance and co-payments. These plans, also offered through private insurers, offer standardized benefits. However, the price among companies can vary widely.  The government Medicare site also offers a tool to compare Medigap plans.

For more information, you can download the Medicare guide or learn more from the Medicare Rights Center.

This is just the tip of the Medicare iceberg, but Patient Navigator can help you help your senior. Please call or email us for a free consultation about a Medicare review for your loved one.

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All too often, however, caregivers’ needs go unmet and the burden they share goes unrecognized.  Doctors, nurses, family and friends make sure the patient comes first, and rightfully so.  However, caregivers also suffer as they watch a loved one battle illness.  Caregivers can feel as though they’re not doing enough to make their loved one comfortable or happy, despite their heroic efforts.  Caregivers can also receive the brunt of a patient’s anger, since typically this role  is filled by a person close to the patient.

The Journal of General Internal Medicine recently released ethical guidelines addressing patient, physician, and caregiver relationships. The medical community is increasingly respecting the role of caregivers and offering guidance on how to develop that relationship.  The guidelines aim to focus on a family-centered approach to treatment thereby decreasing the caregivers’ susceptibility to stress-related illness.  One such recommendation states that physicians should be more accessible and allow for more effective communication not only to the patient but also to the caregivers.

Remember that it’s important for caregivers to be mindful of their own health and needs. Take time out to go for a walk, rest, go to a movie.  Many communities offer respite services to give you some time away.  It can also be very helpful to seek out a caregivers support group in your local community.  Strength is gained when experiences are shared.

For more information and resources for caregivers, please visit the following sites:

http://www.cancer.gov/cancertopics/coping/familyfriends  – National Cancer Institute

http://www.cancer.net/patient/Coping/Caregiving American Society of Clinical Oncology

http://www.cfad.org/  Caring from a Distance

http://www.caregiver.org/caregiver/jsp/home.jsp  Family Caregiver Alliance

Submitted by Heather Matthews, Patient Navigator Cancer Research Specialist

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How about that as a scary thought?  Every single human being on the planet has cancer cells in their bodies.  The good news is that, for most of us, our body’s natural defenses know how to defeat these defective, tumor-causing cells, and they never get the chance to grow up into a full-blown cancer.

I had the pleasure of attending a presentation by Dr. David Servan-Schreiber,  himself a cancer survivor, during the CancerGuides® training in June 2009.*  His delivery was amazing; his presence on the stage mesmerizing.  But what stuck with me was the plain truth – we all have cancer cells somewhere in our bodies. 

Accepting that fact also motivated me to learn more about what to do to try to keep those individual defective cells from joining together and having a cancer party.   Following his advice, outlined in the book “Anti-Cancer – A New Way of Life,” I have made small changes in my life since then.  I try to include freshly ground flax seed in my daily diet, usually in my morning oatmeal or yogurt.  I am proud to say that my ten-year old son often copies me, and grinds his own flax seed into his breakfast.  I definitely am more conscious of the amount of fruits and vegetables that we all eat.  I try to purchase eggs and meat that are grass-fed, and therefore richer in Omega-3s.   I am working to reduce toxic cleaning products and other indoor pollution from our house.   I exercise regularly.

I am falling down, however, on approaching life in a light-hearted way, with laughter and serenity.  Dr. Servan-Schreiber emphasizes that emotional toxicity is as harmful to the body as physical pollutants.  It is easy, and we are programmed very early, to react to problems with anger and negativity.  It is much more of a challenge to find the humor in adversity, to love those who make life difficult for us.  I think these are the most difficult changes of all – the internal ones of the basic self.   Whether you’ve had cancer or not, any person who wants to improve their chances of avoiding cancer should read Dr. Servan-Schreiber’s very important book.

 * CancerGuides® training is offered by the Center for Mind-Body Medicine in Washington, D.C.  It is the country’s only comprehensive training in integrative oncology. To learn more, visit http://www.cmbm.org/

Guest editor:  Debora Harvey, Director of Client Services at Patient Navigator, LLC

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The Case Manager or Patient Navigator: Providing Support for Cancer Patients During Treatment and Beyond – nccn.com.

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My husband and I starting taking a poll amongst our friends and family members, to which the results were completely split down the middle. Some said no, don’t do it, only give him the regular flu shot, others said yes, absolutely vaccinate for swine flu, you’re crazy not to. Our pediatrician said we should vaccinate. He said that doctors have been giving children vaccines for decades. Even the seasonal flu vaccine has a different composition each year so we should treat the swine flu shot as if we are giving him the regular seasonal flu shot. At this visit, my son left after having the regular seasonal flu shot and not the H1N1 shot. I needed more time to think about the subject and to discuss with my husband.

After countless conversations with friends in the medical field, friends with children the same ages and doing my online research at www.flu.gov and www.cdc.gov, I think we’re going to vaccinate. We haven’t done it yet, because the thought of giving my little guy two different flu strains in the same setting terrifies me but we’re going to vaccinate. Now all I need to do is get an appointment with the doctor’s office to vaccinate but they are completely booked. I guess that means that other parents are vaccinating too!

Please let us know your thoughts on the H1N1 vaccination and what you would do.  Submitted by Heather Matthews, Guest Editor, Cancer Research Specialist at Patient Navigator LLC

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Conference Addresses Issues Defining Rapidly Growing Patient Advocate Profession

BERKELEY, Calif., Oct. 13 /PRNewswire/ — The National Association of Healthcare Advocacy Consultants (NAHAC), the nation’s first professional association for people working as healthcare and patient advocates, will hold its first annual conference November 14-15 at the University of California, Berkeley Clark Kerr Campus.

Conference workshops will include topics ranging from best practices for advocacy decision-making through solving health insurance problems, working effectively with physicians, legal issues, advocacy for children, and using technology to maximize efficiency. Case studies will also be presented.

“The founding of NAHAC and this inaugural conference are major milestones on the road to formalizing our profession, creating healthcare consumer protection standards and promoting this rapidly growing field of healthcare advocacy,” says NAHAC founder Joanna Smith.

Conference presenters/topics:

Ann Tardy, Founder, LifeMoxie; Keynote Presenter: “The New World of Healthcare Advocacy — Creating It Together!”

Jeff Belkora, PhD, Director of Decision Services and Assistant Professor of Surgery in the Institute for Health Policy Studies, U.C.S.F.: “Making Good Decisions in a Family Health Crisis”

Linda Garrett, Partner, Risk Management Services: “Confidentiality and Privacy Law for Healthcare Advocates”

Gail Gazelle, MD, Assistant Clinical Professor of Medicine, Harvard Medical School: “Inside the Doctor’s Mind: What Every Advocate Needs to Know”

Maggie Radany, RN, Founder, Radany & Associates: “How to Solve Health Insurance Problems and Be a Hero to Your Clients!”

Dianne Savastano, Founder & President, Healthassist: “Bringing Bob Home: A Case Study in Patient Advocacy”

Elisabeth Schuler Russell, Founder & President, Patient Navigator LLC: “Inside the World of Pediatric Healthcare Advocacy”

Judith Stark, Principal, Judith Stark Consulting: “Harnessing the Power of Technology Solutions for Healthcare Warriors”

Inaugural members of the NAHAC Board of Directors:

President: Joanna Smith, CEO, Healthcare Liaison, Inc., NAHAC Founder

Vice-President: Elisabeth Schuler Russell, Founder & President, Patient Navigator LLC

Secretary: Ricka L. White-Soso, MSW, private healthcare advocate and consultant of FLW Living Well Services

Treasurer: Maggie Radany, RN, MPP, Radany & Associates, health insurance consultant and healthcare advocate

Representation of the Founding Members: Laura Weil, Director, Sarah Lawrence College Master’s Degree Program in Health Advocacy

NAHAC membership is open to individuals interested in healthcare advocacy.

For the conference brochure and more information about NAHAC visit: http://www.nahac.memberlodge.com

 SOURCE National Association of Healthcare Advocacy Consultants

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