HMO flim flammed elder mother

[Sophia3]

Anybody familiar with United healthcare HMO?? They are supposed to give "financial benefits" I guess but severe limitations.

My elderly mother is in a hospital with intermittent dementia and needs to be placed in a nursing home for a few days/weeks to get her stabilized because she is too out of it to go home. She is lucid sometimes but still in and out.

She thought she only had Medicare insurance. Come to find out, she has UNITED HEALTHCARE medicare. They signed- our then 82 year old mom-- up in 2001 w/o explaining things to her or having one of her kids present.

This HMO "Benefit" we just found out, wants my mom to pay $100 a day out of pocket for short term nursing care stay for 36 days? That is a $3600 deductible on top of the current HOSPITAL bills and major tests!? Plus we are limited to only 6 nursing homes and none we are familiar with&^%$#@!

Medicare would cover 100% up to 20 days in interim care? This is a flim flam job and my mom is on a tiny income. She is not aware of the problem.

I am going to call up these UH Care people and let them have it and demand they remove her immediately. Time is critical and of the essence according to the doctor and the psychiatrist. We want to give my mom a chance to stabilize so she can go back to her HOME and live instead of having to sell her home and ban her to a nursing home...but she hates doctors and meds but needs both for dementia and agitation problems.

Have you ever heard of an HMO signing up an elderly person without coming to the house???? If they did this, it was w/o our knowledge and my mom has no clue this is even a problem. She can be sharp and with it most times (until recently, of course ) but out of it when overwhelmed with information.

I am livid. Is there somebody to complain to about an HMO switching an elder person w/o giving them the fact? We are OUTRAGED as a family.

Thank you,

I am not yet in an emergency guardianship but we as a family are LIVID!! If you can help or have been in similar situation, please let me know.

[avais1]

Hello,

Sorry you are going through this. Medicare is not administered necessarily by the gov't. You have to pick the administrator (meaning healthplan), be it UnitedHealth, BlueCross BlueShield, Aetna, etc. I would suggest contacting the customer service number on the back of the ID card, and asking for help. Also, demand that they send you an SPD (Summary of Plan Details - otherwise known as a benefit book) or a Certificate, explaining the exact benefits of the plan. It should outline deductibles, out of pocket maximums, benefits, etc.

Good luck to you, I know it is a pain.

Avais

[morgan617]

Is this her part B of medicare? I just got my medicare from ssdi and they automatically sign you up, unless you let them know in writing you don't want it. They may have switched her automatically and sent her a little blurb she might have ignored. It's pretty easy to do.

It's pretty infuriating too, and not only that, if you refuse it when it's given they raise the price 20% if you ever do need it. Blasted one way or another. However, no matter which plan HMO went into effect, the amount out of pocket should be pretty much the same. No matter what the name of the HMO is, so this is really odd. Let us know what happens. morgan

[Sophia3]

thanks

it took an hour or more of being on the phone but when I explained the situation, they are going to disenroll her the end of this month. AND do an internal investigation of how my mother was mislead about this switch.

I just sent a fax to confirm the disenrollment.

She HAS ALWAYS HAD MEDICARE..it automatically happens when you are disabled or turn 65.

Yes it was her part B plan.

[morgan617]

The whole purpose of the B is to defray costs, but that doesn't sound like much of a cost saver to me! I'm glad you got it straightened out.

When I got my medicare and read up on it, I couldn't believe it. For only 80 dollars a month they would cover 20% of what was left after my hubs insurance paid. So even with medicare and the supplement and my hubs insurance, I would still owe money, so I told them to stick part B where the sun doesn't shine. But I think the way they do it is very misleading. You should NOT be automatically enrolled in B. It confuses too many people, especially the elderly. If you don't respond, they just pick one for you. Unbelievable. morgan p.s. and it's not like you get enough to live on to begin with.....