Navigating the health insurance maze
February 6, 2019
As I write this, my husband Lynn is still at Share Medical Center in the swing bed program. The first time I heard the term, I visualized a bed suspended from the ceiling. I could not imagine how that benefited a patient. It’s actually a transitioning program between being a hospital patient (acute care) and moving on. That move might be going back home or going to a nursing home or other care.
Swing bed is a skilled nursing program. Both local nursing homes also offer skilled nursing. The patient is assessed and receives needed therapy. In Lynn’s case, he’s getting physical therapy five days a week. He’s also getting plenty of attention from speech therapy, which addresses his ability to swallow food by mouth and his nutritional needs. He’s still getting most of his nutrition through a stomach tube.
Lynn’s in a regular hospital bed with nursing staff checking on him throughout the day. His vital signs are checked regularly. His prescribed medications are administered. He has restroom and shower facilities in his room or he may be treated to a whirlpool bath located down the hall. A case manager is in charge of the swing bed program and coordinates all the care. Lynn’s primary care physician oversees his care and makes visits.
During his recent hospital stay in Oklahoma City for a blood clot in his lung, Lynn was mostly confined to a bed so he lost some muscle tone. Hopefully the physical therapy he’s receiving will help him to avoid falls when he returns home.
Before Lynn was transferred to swing bed in Alva, our daughter talked to his oncologist and his Oklahoma City case manager about insurance coverage. She also called our supplemental insurance provider to see what was covered. After a hospital stay of at least three days, Medicare covers the total cost of skilled nursing for the first 20 days. Our supplemental insurance will cover the co-pay amount of just over $170 a day after the 20 days, and both end after 100 days.
We’re not expecting Lynn to stay long, and he’s already getting restless. Being in a hospital room can be tough. The patient is not in charge of anything.
As we look at the “what ifs” down the road, we have been checking on Medicare coverage of nursing homes. If you’re looking at long term care (also called custodial care) only, Medicare doesn’t cover it, You pay 100 percent for non-covered services, including most long-term care. Help with basic personal tasks of everyday life, sometimes called activities of daily living, are not covered
Sometimes your Medicare supplemental insurance will provide partial coverage, but it’s a good idea to check it out. There are specific long term care insurance policies to provide this coverage, and the younger you are when applying, the less they cost. There’s also an option for converting life insurance policies to pay for long term care.
Those who qualify can get some help from the state Medicaid program. But usually a patient’s assets (house, land, savings, pension) must be exhausted to qualify.
Our daughter was concerned because her husband’s family was surprised by all this upon the death of a relative. Assets expected to go to family members had to be sold to pay long term care bills.
I was surprised over the weekend to see that Lynn was scheduled for a PET scan on Tuesday afternoon. No one had notified us. Lynn has short-term memory issues, but he managed to remember his doctor had mentioned it. He told our daughter Saturday, and she told me. I verified it on the Mercy Hospital’s patient portal.
While I might have had time to make arrangements to check Lynn out of swing bed for the trip, I’m too busy with the Newsgram on Tuesdays to go out of town. It took being transferred three times on the phone, but I finally reached the right person to cancel the appointment. We still want a PET scan, but I’m going to call when we have a date for Lynn’s release from swing bed.
When Lynn was in Oklahoma City, his sister visited him daily. Our daughter and I alternated days for visiting. And he had some visits from friends who live in that area as well as an Alva friend who was in the city. He really appreciated all the company.
Now that he’s feeling better, Lynn is more alert and ready to talk to people. I know he’s had several visitors since he’s been at Share Medical. It’s a great break from the tedium of being in the hospital, and he doesn’t mind being awakened to visit. Lynn also continues to enjoy the cards he receives.
We’re not sure what happens next. It depends on the results of the PET scan, which will show if his cancer has been reduced, has simply been stopped from growing more or has metastasized to other areas. We appreciate all of you who are keeping us in your thoughts and prayers.