So many questions, so little time!! 
it's so nice to be back in touch with y'all!!
Thanks once again for your continued support. It really means a lot to my mental, spiritual and emotional well-being! (OMG. Did the ol' Cat go mushy on us???? She MUST be sick....Cat is NEVER mushy. Maybe she's gettin' old...yeah, that's what that was...a senior moment...)
The mysteries of the modern health care billing system... frankly I've stayed as far away from the billing crap as I can. I have enough stuff in my litter box just to stay alive; I don't need that, too! Here's what little I know:
We have a private health insurance plan. A good plan. Got it through Tom Cats company, and when he retired, could keep it (but of course pay the premiums ourselves). Which we do, now. Send off $880 a month, $440 each. Tom Cat and I are also on Medicare, parts a,b,c,d. Premiums come out of what otherwise would be cash sent to us.
Before TC reached actual retirement age --he retired at age 57-- his medical bills were submitted first to the insurance company, and then to us. Fortunately he was quite healthy so most of his medical costs were paid for by the insurance company, and we had only a little we'd have to pay. Now that he is well past "normal" retirement age, bills first go to Medicare, which is considered his primary insurance, then to our insurance company, then to us. Only a few have gotten that far far down the money chain; mostly all his stuff so far has been paid for entirely. (Our private policy does have co-pays for medicines, some tests, but basically for now, most everything for him has been covered.) Mushy alert: Thanks for thinking about and asking about him. That means a lot to both of us. As you know, he has a bunch of ugly health issues going on, too. Getting old ain't for cowards.
Then there's Cat. I've been on social security disability income, SSDI, for a lot of years. While TC was working, MY medical bills first went to Medicare (which is what SSDI is -- Medicare, the amount you receive based on your working history (how many years worked before becoming disabled, and how much you salary was before being declared disabled). The rest of the charges was then sent to the company's plan, then to us. SSDI (medicare) was my primary insurer, then the private insurance, then us. Again, we paid very little for anything, a few co pays, a few random things over the years. For the first 4 years after diagnosis there were a lot of medical costs: a few major flares threw me into the hospital, then I developed pulmonary embolism, had other issues. Then everything, including the MS settled down. For years, there, we had almost no issues: see a doctor once a year for an annual physical, flu shots, other usual stuff.
Fast forward to the present. One that we're both past 65, my SSDI has "converted" to straight Medicare, and Medicare has become our primary insurance, then our private plan, then us.
So now I'm in the hospital. If I'd stayed less than 3 days, bills could have gone several routes: if the doctor coded my stay as "for observation", Medicare won't pay anything, so the bill would go directly to private insurance (pi), then to us. A different code, "treatment", sends the bill first to Medicare, then pi, then us. Another code sends the bill directly to the patient.
I stayed five days. Medicare will be billed for the entire stay, and will pay for it. But there are restrictions. Once I was out of surgery, wounds recovering, no fever, no other underlying health issues, everything stable --no fever, blood pressure stable, blood work looking good, etc. Medicare essentially said, "OK, she's stable, all you're doing now is maintaining her: that can be done elsewhere".
In other words, a nursing home, as expensive as these are, is cheaper than staying in the hospital. Going home and having visiting nurses come in, and relying on a patient's family/friends to provide support, is cheaper yet. Medicare pays for visiting nurses, home health aides, so long as the patient "shows signs of improvement". So it pays to be nice to, even befriend, visiting nurses: they have to d o an assessment every 6 weeks to Medicare, so it is up to them to decide just how much you're improving, whether to extend their services for another 6 weeks,etc.
I'm coded (and this probably the exact wording of it) as " stable but medically complex". Meaning, needs lots of support to stay that way, and improve. You think???? Now, if I HAD lots of support, I could have gone home: visiting nurses could come in 6 days a week during "regular hours", for emergencies on Sundays. But of course, they would be at my bedside 24/7. So except for the hour a day they would be there, Tom Cat would be responsible for the rest: monitoring the antibiotics iv; the wound vac (which, if it breaks down, which it does often, breaks at night or on Sunday afternoon), the colostomy bag (of poop; changing bags, changing the whole appliance), the urinary catheter. Feed me. Dress me. Do my laundry. Clean up my messes when the catheter leaks, or the colostomy bag leaks. General housekeeping. We have small, elderly family nearby. No kids, no younger relatives who could help. So home support is clearly not in place.
So I'm in this nursing home where all that maintenance support is provided. Medicare will pay entirely for this for 21 days. Then they'll start splitting costs with my private insurance, then us. I and my home situation will be assessed every 10 days after that. If I'm still medically complex and the home situation stays the same, Medicare and private insurance will pay. Once the complexity starts to diminish -- the antibiotic iv ends, and/or the wound vac removed, I will be assessed again. And again, assuming I continue to improve, the situation assessed again.
So I'll be here awhile. Ideal situation: antibiotic iv ends (in 6 weeks, how long it's supposed to be attached) and I go on oral antibiotics. The wound either heals entirely, or at least the wound vac is disconnected,and daily dressings are tended by TC. My legs regain at least enough strength to be able to transfer from bed to wheelchair, at which time I can tend to my urinary catheter and colostomy by myself, dress myself, get back some description of "normal" in my life. If I reach that point, then I can go home, get visiting nurses, aides, physical therapists to come in. Tom Cat jumps up and helps ( but is not fully responsible). I'm not there yet, on many levels. So I'm here for 6 weeks at a minimum, longer as necessary..
Isn't insomnia a wonderful thing. Fell dead asleep at 8 pm, woke at 1:30 am, still awake. Haven't seen anyone in my room. But then, no alarms have gone out, iv is quietly hissing, wound vac quietly humming, catheter, and colostomy bags doing their jobs, just me, wide awake....boring you.
it's so nice to be back in touch with y'all!! Thanks once again for your continued support. It really means a lot to my mental, spiritual and emotional well-being! (OMG. Did the ol' Cat go mushy on us???? She MUST be sick....Cat is NEVER mushy. Maybe she's gettin' old...yeah, that's what that was...a senior moment...)
The mysteries of the modern health care billing system... frankly I've stayed as far away from the billing crap as I can. I have enough stuff in my litter box just to stay alive; I don't need that, too! Here's what little I know:
We have a private health insurance plan. A good plan. Got it through Tom Cats company, and when he retired, could keep it (but of course pay the premiums ourselves). Which we do, now. Send off $880 a month, $440 each. Tom Cat and I are also on Medicare, parts a,b,c,d. Premiums come out of what otherwise would be cash sent to us.
Before TC reached actual retirement age --he retired at age 57-- his medical bills were submitted first to the insurance company, and then to us. Fortunately he was quite healthy so most of his medical costs were paid for by the insurance company, and we had only a little we'd have to pay. Now that he is well past "normal" retirement age, bills first go to Medicare, which is considered his primary insurance, then to our insurance company, then to us. Only a few have gotten that far far down the money chain; mostly all his stuff so far has been paid for entirely. (Our private policy does have co-pays for medicines, some tests, but basically for now, most everything for him has been covered.) Mushy alert: Thanks for thinking about and asking about him. That means a lot to both of us. As you know, he has a bunch of ugly health issues going on, too. Getting old ain't for cowards.
Then there's Cat. I've been on social security disability income, SSDI, for a lot of years. While TC was working, MY medical bills first went to Medicare (which is what SSDI is -- Medicare, the amount you receive based on your working history (how many years worked before becoming disabled, and how much you salary was before being declared disabled). The rest of the charges was then sent to the company's plan, then to us. SSDI (medicare) was my primary insurer, then the private insurance, then us. Again, we paid very little for anything, a few co pays, a few random things over the years. For the first 4 years after diagnosis there were a lot of medical costs: a few major flares threw me into the hospital, then I developed pulmonary embolism, had other issues. Then everything, including the MS settled down. For years, there, we had almost no issues: see a doctor once a year for an annual physical, flu shots, other usual stuff.
Fast forward to the present. One that we're both past 65, my SSDI has "converted" to straight Medicare, and Medicare has become our primary insurance, then our private plan, then us.
So now I'm in the hospital. If I'd stayed less than 3 days, bills could have gone several routes: if the doctor coded my stay as "for observation", Medicare won't pay anything, so the bill would go directly to private insurance (pi), then to us. A different code, "treatment", sends the bill first to Medicare, then pi, then us. Another code sends the bill directly to the patient.
I stayed five days. Medicare will be billed for the entire stay, and will pay for it. But there are restrictions. Once I was out of surgery, wounds recovering, no fever, no other underlying health issues, everything stable --no fever, blood pressure stable, blood work looking good, etc. Medicare essentially said, "OK, she's stable, all you're doing now is maintaining her: that can be done elsewhere".
In other words, a nursing home, as expensive as these are, is cheaper than staying in the hospital. Going home and having visiting nurses come in, and relying on a patient's family/friends to provide support, is cheaper yet. Medicare pays for visiting nurses, home health aides, so long as the patient "shows signs of improvement". So it pays to be nice to, even befriend, visiting nurses: they have to d o an assessment every 6 weeks to Medicare, so it is up to them to decide just how much you're improving, whether to extend their services for another 6 weeks,etc.
I'm coded (and this probably the exact wording of it) as " stable but medically complex". Meaning, needs lots of support to stay that way, and improve. You think???? Now, if I HAD lots of support, I could have gone home: visiting nurses could come in 6 days a week during "regular hours", for emergencies on Sundays. But of course, they would be at my bedside 24/7. So except for the hour a day they would be there, Tom Cat would be responsible for the rest: monitoring the antibiotics iv; the wound vac (which, if it breaks down, which it does often, breaks at night or on Sunday afternoon), the colostomy bag (of poop; changing bags, changing the whole appliance), the urinary catheter. Feed me. Dress me. Do my laundry. Clean up my messes when the catheter leaks, or the colostomy bag leaks. General housekeeping. We have small, elderly family nearby. No kids, no younger relatives who could help. So home support is clearly not in place.
So I'm in this nursing home where all that maintenance support is provided. Medicare will pay entirely for this for 21 days. Then they'll start splitting costs with my private insurance, then us. I and my home situation will be assessed every 10 days after that. If I'm still medically complex and the home situation stays the same, Medicare and private insurance will pay. Once the complexity starts to diminish -- the antibiotic iv ends, and/or the wound vac removed, I will be assessed again. And again, assuming I continue to improve, the situation assessed again.
So I'll be here awhile. Ideal situation: antibiotic iv ends (in 6 weeks, how long it's supposed to be attached) and I go on oral antibiotics. The wound either heals entirely, or at least the wound vac is disconnected,and daily dressings are tended by TC. My legs regain at least enough strength to be able to transfer from bed to wheelchair, at which time I can tend to my urinary catheter and colostomy by myself, dress myself, get back some description of "normal" in my life. If I reach that point, then I can go home, get visiting nurses, aides, physical therapists to come in. Tom Cat jumps up and helps ( but is not fully responsible). I'm not there yet, on many levels. So I'm here for 6 weeks at a minimum, longer as necessary..
Isn't insomnia a wonderful thing. Fell dead asleep at 8 pm, woke at 1:30 am, still awake. Haven't seen anyone in my room. But then, no alarms have gone out, iv is quietly hissing, wound vac quietly humming, catheter, and colostomy bags doing their jobs, just me, wide awake....boring you.
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