My father always told me there is “No such thing as a free lunch!” That’s why I was very wary when I received a phone call from my client’s Medicare Supplement insurance company representative. (I serve as Power of Attorney for health care for my client.) The insurance representative was very excited when she informed me that my client ‒ who is 99 years old, has advanced dementia and lives in a nursing home under Medicaid ‒ was eligible for a new program that would not only broaden her health care coverage, but also add dental insurance free of charge. As a former insurance broker, my antennae went up immediately: More coverage, free of charge? Here are stipulations of the policy:
Podiatry Services – 4 visits
Vision Services – $300 every 2 years toward lenses and frames
Hearing Services – Includes annual hearing exam and $2,000 allowance every 2 years toward hearing aids
Transportation – 12 roundtrips to offsite medical appointments at no additional cost
$155 / quarter, $620 annually to purchase out of the company’s “catalog”
$1,800 per year for covered dental services
Well visits every 30 days with a clinician, with a follow-up call to family. Residents of the client’s community are provided with a program “Plus” clinician at no additional cost. “The role of our clinician,” explains the insurance company, “is to avoid unnecessary hospitalizations and treat our residents in their home.” A Nurse Practitioner provides increased communication with our resident’s families and works alongside the current primary physician to address health concerns that residents and families may have. The client’s primary physician remains the same; nurses and aides’ care stay in place. The company further states, “Our program is designed to offer more support to the residents and families with urgent health and wellness care.” While I saw lots of advantages to what was being offered, I also saw the possibility of the door being opened for the delivery of services to my client that might not be necessary. Lo and behold, I was right.
This week I received a call from the director of the memory unit where my client resides. She told me a dentist had been in to see my client, and he wanted to perform root extractions on four of her teeth. In order to save a tooth, root extractions need to be performed when a tooth is cracked, a cyst forms near the root, the tooth is subject to reoccurring infections, or the tooth is curved. My client has none of the above and has always eaten heartily. Treatment would require my client to receive a local anesthetic (she would never hold still) or general anesthesia. After such surgery, you can expect pain, treatment with painkillers, swelling, and gum soreness to the surgical wound. The nursing home staff would have to apply ice and watch the area for signs of infection, a necessity and luxury that is not available due to limited staffing and time.
My response was, “He wants to do oral surgery on a person with dementia who is 99, when she has never had troubles?” The director burst into peals of laughter and said, “My thoughts exactly!” So let the recipient of the free coverage beware! And that’s the tooth!
Do you need a second opinion? Let Andrea Donovan Senior Living Advisors help. Call us at (708) 415-2934 or email us. Please visit our website. Please watch my video to learn how the process works and learn what some clients have to say.