(In yesterday’s installment, Vicki’s dad was taken by Medevac helicopter to a hospital for $24,000. At the hospital, the brain tumor was discovered. The bills for his care would be covered under the state’s no-fault auto insurance plan up to $50,000, which would cover about 25 minutes of his first day in the hospital. Money quickly became an issue.)
These questions became paralyzing when it was time to choose a rehab or hospice facility for my father’s next stage.
For example, a rehab facility will charge Medicare a daily rate for up to 20 days of inpatient care, but they will not provide transportation to a hospital for radiation treatments because that is already “covered” in the daily rate. Of course, the facilities themselves do not consider that “covered” and so they don’t provide it, and my father ended up having to stay as an inpatient at the hospital for his three-week radiation course, even though he was at first considered well enough for rehab.
Similarly, the rehab facilities that said they also provided hospice services if a patient grew sicker explained that the hospice services covered were “outpatient” (though provided inside the facility to residents) and did NOT include room and board (which Medicare doesn’t pay for because it is “custodial care”).
Medicare will cover 60 days of hospital inpatient care and my father was discharged to a VA hospice on his 60th day. We have not yet received the slightest hint of what the hospital charges will actually be, considering co-pays, exclusions, and the rest of the red tape.
We wondered: were those daily infusions of platelets covered 100 percent as inpatient care or 80 percent as
“Transfusions, Blood Products” according to the Medicare handbook? If there were people to ask at the hospital, we were never referred to them, and even the social workers couldn’t answer the simplest of Medicare questions.
Once I was referred to an obscure, unmarked office to discover that the friendly woman there handled only private medigap insurance. She too had no idea where to send me for Medicare questions. Was my father the only patient in this 600-bed hospital insured by Medicare?
If the medical payment system were a video game, you could say that my sisters and I were diligent enough in our research to advance to the first level. It was a huge relief, then, when we were able to return to the VA system.
My father had had two surgeries for kidney cancer there in the past two years, and had never seen a bill from them – not a single co-pay or even a scary total.
When the radiation treatments failed and my father needed a hospice facility, he and we were extraordinarily lucky to move to a nearby in-patient hospice in a VA hospital. When they said they covered “everything” they did: inpatient care, doctor’s fees, medications, transportation to the facility and then transportation to the funeral home and a burial allowance when the time came.
The painful process of this long goodbye became simpler and more humane. We worried less about the costs or the communication. The hospice director called us over the weekends to tell us how our father was doing, then after his death to check on our bereavement.
What is the moral of this story? I began the process, and this piece, wanting more financial information from “the system,” wanting to know exactly what everything cost and who would pay for it. I wanted control and transparency.
But that may be a response to all the uncertainties of illness itself: when I could confidently ignore the costs at the VA, that was more reassuring than the control I had originally wanted.
In the end (and who knows if this is “the end” because the bills have only started to appear…) all my sisters and I wanted was the freedom to concentrate on our father in his last few weeks.
We wanted to sit bedside instead of chasing down elusive doctors and administrators for answers to our questions. We wanted to choose facilities based on care and comfort rather than cost and coverage.
That was rarely possible in the hospital, but at least we did find a measure of calm and focus in his last week at the VA.
Editor’s note: Thank you, Vicky. Our hearts go out to you and your sisters.
(From V.O.: Please note that insurance information is only based on my own knowledge and cannot be considered authoritative!)