• Tue. Mar 28th, 2023

By Dr. Tyra Oldham

An essential part of caregiving for the family member is insurance. The care and support of insurance are tantamount to essential care. The issue that children and caregivers have regarding family is activating insurance when necessary. The ability to advocate with insurance is stressful, time-consuming, and vital to your loved ones. The professional caregiver they too, are impacted by insurance in that they may not have the services or supplies necessary for their client’s healthy lifestyle day-to-day.

Under the last administration, healthcare has changed. The decisions of your loved one’s care are no longer in the hands of the doctor’s order when using managed care. Under managed care, even premium, the insurance company has the last say. The inability to intervene in your loved one’s care is stressful, lengthy, and time-consuming. The goal is to become an advocate for those you love. Advocacy is the difference between care and no care. 

Even with advocacy, you are fighting a battle, but yet it is a battle worth doing.

Today, people are sent home after knee and hip surgeries to attend outpatient rehab while convalescing at home. Previously patients, after undergoing surgery, were sent to rehabilitation to heal, regain strength, and be monitored. Today hospitals are sending patients home rather than rehabilitation to recover. Today the family member is the rehabilitation solution and care provider acting as a nurse and responsible for gaining access to therapies. One answer is to appeal the findings of your insurance directly.

Have you ever had to appeal to the insurance company on behalf of your loved one? It is not wimps! 

Make sure you have the power of attorney or health care proxy approvals to submit. You will not be able to discuss their care without these documents in place. The best solution is to provide these documents ahead of time to your loved ones’ hospital, pension, insurance, Social Security, and Medicare.

The family caregiver or POA (power of attorney) holding the healthy proxy and rights of the patient are responsible for the life decisions of their family. Imagine that the POA is the spouse or partner who is also infirmed or older. When both need care and one is healthy enough to be considered a caregiver, this places an enormous load on that other person. Insurance has defaulted to having the able body person be the default nurse, caregiver, and therapist. I, too, have experienced being relegated to these services despite the fact that I am not a physical or occupational therapist. Insurance has defaulted me to these professions without the expertise to deliver. My gosh, I am strong and capable, but the person who is the active caregiver is not all-encompassing or knowing. This problem is not just an aging issue but a parental or family issue for those who care for one another. The importance of advocacy with insurance is to make sure that the insured has access to positive care.

As an advocate, the role is to gain information and respond prudently to the insurance company. As much as you like to scream and yell at the insurance representatives, this action is far from supportive of accomplishing your goal. Keeping focused and calm at all times is required and necessary for proactive-empathetic communication that expresses the needs of your loved one to the company.

Never be afraid to actively appeal and go up the ladder of services to access the proper services required. Purposeful steps are necessary to make your demands known to assist your family member or client. Deliver precise, concise needs that your family member requires for care. Consider the impact without the care. Critically analyze the overall needs and why the insurance is vital. Stay focused and seek help when needed, such as Pro Seniors, to gain legal support. AARP for advocacy and advice. Social workers and your medical professionals. And if your loved one is experiencing mental disease, contact Alzheimer’s Association. This month is Alzheimer’s Month. Please give!

For more information on care support and caregiving advice, write or email the “Care Corner.” Want to discuss care? Care Corner is that place to talk care, address questions for current and potential caregivers, and provide suggestions on agencies, services, and tips to assist in a care journey. (Read more of the article from the Herald Newspapersubscribe now

The Care Corner is for everyone, no matter their age or process in care. For more information on caregiving, send your questions to Care Corner at the Cincinnati Herald or via email at care@carecorner.info.