VA Benefits: Top Reasons Claims are Denied

The VA’s own website (www.va.gov) confirms that 75% of all VA pension applications (commonly referred to as Aid & Attendance) are denied the first time. The main reason VA applications are denied is because they are not complete and well-documented.

Here are 5 things you should know to avoid having your claim denied:

# 1: Failure to Document Income and Unreimbursed Medical Expenses. On the application, the VA can ONLY confirm the amount of your Social Security benefits independently. Everything else should be documented with a written explanation, this year’s award letter or an annuity agreement. When in doubt, document it. Unreimbursed Medical Expenses should be documented on the VA form 21-8416. If you have any other recurring, ongoing or continuous unreimbursed Medical Expenses (including R&B), document them!

# 2: Documenting Shortfalls. If your Unreimbursed Medical Expenses, especially your Room & Board (R&B), exceed your income, the VA will ALWAYS delay your claim to clarify this. So, anticipate this question! If you are using savings or assets to meet this shortfall every month, explain this as an attachment to your application. If your assets are depleted, and a friend, sibling or family member is supplementing your R&B, explain this. To be sure the VA understands what is happening, write a simple loan agreement and submit it with your application. This will prove that you are borrowing this shortfall every month.

# 3: Documenting Dependents. According to the VA, a “dependent” is younger than 18, where the veteran is the father, or the veteran is married to the mother (step-children are fine). Grandparents must have court-issued adoption decrees. If dependents are under 23- years- old, they must be in school full-time. Spouses are dependents, but their income also counts, as well as their Unreimbursed Medical Expenses.

# 4: Failure to Respond to Clarifications. Always answer VA letters or phone calls as soon as possible. If you need more time, send a letter saying “I’m working on it”. You have at least 60 days to respond and can supply the information within one year and still have a valid claim.

# 5: Missing or Incomplete Information. The VA pension applications are multiple-paged and have hundreds of questions. Address and answer every single one of them. If the question is non-applicable, answer “N/A”; if income is zero, answer with a “0″. NEVER, EVER leave a space blank.

With the VA, you can never provide too much information. If they have to write you for clarification, your claim will be delayed or denied. Always include your phone numbers, an email address and a next-of-kin’s contact information with every application.

Hospice ... a circle of care

by Patricia Grace

The word "hospice" stems from the Latin word "hospitium" meaning guesthouse. During the 1960's, Dame Cicely Saunders, a British physician began the modern hospice movement by establishing St. Christopher's Hospice near London. Today, hospice care provides humane and compassionate care for people in the last phases of terminal illness so that they may live their remaining life to the fullest and as pain-free as possible.

The primary focus of hospice is to maintain a quality of life through comfort, dignity and understanding. It encompasses the physical, psychological and spiritual needs of terminally ill patients, while supporting the well-being of caregivers. Whether provided in the home, hospital, long-term care facility, or anywhere else, hospice is a compassionate way to deliver care and supportive services to terminally ill patients. Services are provided on the basis of need, not the ability to pay.

Hospice & Palliative Care are they the same?

The goal of palliative care is to prevent, relieve, reduce, or soothe the symptoms of diseases or disorders. Palliative care does not try to cure disease. It is concerned with the emotional, spiritual, and practical needs of the affected person and those close to them. Palliative care is important for people who are thought to be at imminent risk of dying, those who are extremely ill, or those who are living with serious complications at the final stages of chronic diseases.
Palliative care focuses on managing symptoms, providing comfort, helping the patient complete "life business," healing relationships, and helping the family and friends who are grieving.
Hospice care is one form of palliative care with the goal to alleviate symptoms and improve quality of life. In contrast to traditional palliative care, hospice care is appropriate when there is a life expectancy of six months or less. When curative treatments are no longer working and/or a patient no longer desires to continue them, hospice becomes the care of choice. Traditional palliative care, on the other hand, can be given at any time during the course of an illness and in conjunction with curative and aggressive treatments.

While most people identify hospice with a cancer diagnosis a large portion of hospice patients suffer with COPD (Chronic obstructive pulmonary disease), heart disease (Congestive heart failure), neurological disorders (Parkinson’s disease), Alzheimer's disease/Dementia, and AIDS.

Patients and families who choose hospice are the core of the hospice team and are at the center of all decision making. A multi-disciplinary team supports the patient and the family. This team lead by a physician consists of nurses, aides, social workers, spiritual care givers, counselors, therapists and volunteers, family and the patient. All play an important role in the circle of care.

Services provided by this multi-disciplinary team include:

• Nursing services - A patient is assigned a case manager nurse who typically visits 1 to 3 days a week. Patients and their caregivers also have access to 24-hour on-call nurses.

• Physician participation - Patients are often cared for by their regular physician in cooperation with a hospice medical director.

• Medical social services – Social workers to focus on the emotional, financial and social stresses associated with terminal illness.

• Counseling Services - to include pastoral or spiritual support, bereavement counseling for family and caregivers up to one year after patient's death, and dietary services as appropriate.

• Home health aide (HHA) services - HHA help patients with their personal care and typically visit 2 to 3 times per week.

• Medications - all medications that are related to the hospice diagnosis and those that are intended to alleviate symptoms.

• Medical equipment - Equipment that is necessary for providing safe, comfortable care in the patient’s home environment is supplied by hospice. This may include a hospital bed, wheelchair, and oxygen.

• Other medical supplies may include adult diapers, bandages, and latex gloves.

• Laboratory and other diagnostic studies that are related to the terminal illness

• Therapists as appropriate, which may include: Physical therapy;Occupational therapy; Speech therapy. Additional services such as aromatherapy, pet therapy and music therapy may be available through individual hospice agencies and their volunteer and charitable donation programs.
  

Who pays for Hospice?

• Medicare - if the terminally ill individual is a Medicare beneficiary, hospice is a covered benefit under Part A. All other Medicare services continue under Parts A & B, including those of the person’s attending physician. Hospice payments do not interfere with any other Medicare payments for other illnesses, diseases or care. Hospices listed in HospiceDirectory.org will indicate if they are Medicare certified.

• Medicaid - as of 2006, 45 states plus the District of Columbia offer hospice care as a covered Medicaid benefit. In general, Medicaid hospice benefits parallel the Medicare benefit, although there may be some variations in certain states. Hospices listed in HospiceDirectory.org will indicate if they are Medicaid certified.

• Private Insurance - most insurance plans issued by employers and many managed care plans offer a hospice benefit. In most cases, the coverage is similar to the Medicare benefit, although there may be some variations between employers.

• Private Pay - if insurance coverage is unavailable or insufficient, the patient and the patient’s family can discuss private pay and payment plans.

• Tricare - is the health benefits program for military personnel and retirees. Only Medicare-certified hospices can provide for the TRICARE hospice benefit, therefore it is important that patients and family check with their Health Benefit Advisor or Health Care Finder to help them locate a qualified hospice agency.

Under Medicare law, no person may be refused hospice care due to inability to pay. Each hospice has a financial specialist on staff to answer questions about receiving financial assistance. Funds may be available from donations, gifts, grants or other community sources to help cover the costs of care.

Hospice care is covered under Medicare if:

• The patient is eligible for Medicare Hospital Insurance (Part A);

• The patient’s doctor and the hospice medical director certify that the patient is terminally ill with six months or less to live if the disease runs its expected course.

• The patient signs a statement choosing hospice care instead of standard Medicare benefits for the terminal illness;

• The patient receives care from a Medicare-approved hospice program.

Approval for hospice is required even if the agency or organization is already approved by Medicare to provide other kinds of health services. Patients can find out whether a hospice program is approved by Medicare by asking their physician or checking with the agency or organization offering the program. This information also is available from local Social Security offices.

Once hospice is initiated are other Medicare benefits available?

When Medicare beneficiaries choose hospice care, they give up the right to standard Medicare benefits only for treatment of the terminal illness. If the patient, who must have Part A in order to use the Medicare hospice benefit, also has Medicare Part B, he or she can use all appropriate Medicare Part A and Part B benefits for the treatment of health problems unrelated to the terminal illness. When standard benefits are used, the patient is responsible for Medicare’s deductible and coinsurance amounts.

What is not covered?

All services required for treatment of the terminal illness must be provided by or through the hospice. When a Medicare beneficiary chooses hospice care, Medicare will not pay for:

• Treatment for the terminal illness which is not for symptom management and pain control;

• Care given by another healthcare provider that was not arranged for by the patient’s hospice; and

• Care from another provider which duplicates care the hospice is required to provide.

To determine whether a Medicare-approved hospice program is available in your area, contact the nearest Social Security Administration office, your state or local health department, your state hospice organization, or call the National Hospice Organization HelpLine (800) 658-8899

Hospice continues after death

Bereavement is the time of mourning after a loss. The hospice care team works with surviving loved ones to help them through the grieving process. A trained volunteer, clergy member, or professional counselor provides support to survivors through visits, phone calls, and on-line support, as well as through support groups. The hospice team can refer family members and care-giving friends to other medical or professional care if needed. Bereavement services are often provided for about a year after the patient's death.

Hospice care also addresses a person’s spiritual needs. Since people differ in their spiritual and religious beliefs, spiritual care is offered to meet an individual’s specific needs. It may include helping you to look at what death means to you, helping you say good-bye, or helping with a certain religious ceremony or ritual. There are many books in print to help deal with death and dying, “Facing Death, a Companion in Words and Images” by Linda Watson, Photography by Maggie Sale, is a beautiful compilation of photographs and inspirational passages that can help nourish the most wounded spirit. "Becoming Dead Right", a hospice volunteer in urban nursing homes, by author Frances Shani Parker, provides a blueprint on how we should approach the end of life.

Losing a loved one is extremely painful and brings out a variety of emotions…shock, anger, sadness and guilt. Accepting them as part of the grieving process and allowing yourself to feel what you feel is necessary for healing and embraces the spirit of hospice care.

Overnight Care Program for Dementia’s Restless Minds

There are numerous daycare programs across the country for Alzheimer's sufferers, notes Laurence Harmon from Great Places on his blog, but the ElderServe at Night dusk-to-dawn drop-off program at the Jewish Home at Riverdale in NY, is thought to be the only one that picks up participants at their homes in the early evening and provides activities--painting, dancing, chatting, or just relaxing or getting a massage--from seven in the evening and returns them home, rested and showered, ready for the new day at seven the next morning.

For families who choose to continue care for their relative at home, the ElderServe at Night program offers a much needed opportunity for rest, relief from the burdens of care-giving and a good night’s sleep to restore themselves for ongoing care of their family members at home. Read more ...

Eldercare Lessons: Quality of Life - Rudy's Story

By Rita M Files

Throughout the years of working in the elder care industry, I have had the good fortune to meet a handful of people who have positively impacted my life on both a personal and professional level. The lessons I learned from them have changed my view on my own “golden” years and the true meaning of the quality of life.

One person who stands out the most is my beloved Rudy. He and his longtime companion, Helena—after spending the previous 40 years living in an apartment in New York City in a neighborhood laden with crime and danger—reluctantly agreed to move to a senior living community after much pressure from both their families. Their home had become a virtual prison, complete with bars on their first-floor apartment windows and multiple locks on the door. Neither Rudy nor Helena had been able to leave their home unescorted for several years.

My first encounter with them was the day they moved to the senior living community where I was working at the time. Quiet and sullen, they both appeared frightened, tired, and resigned to living in “a place like this.” Helena, noticeably the younger of the two, seemed to take the lead. Rudy appeared to be a shell of a man as he held his partner’s hand tightly and shuffled along through the tour of their new home.

As we approached the main resident gathering area, also known to most as the “piano room,” I was somewhat relieved that our tour would end here. As we entered, Rudy suddenly stopped and gazed for several minutes at the beautiful white grand piano that was the focal point of the room. Seeing what I believed to be a sparkle in his eyes, I asked, “Do you play?” He responded “my whole life.” Seizing the moment, I asked Rudy if he would play a song for me, and he readily agreed. As he approached the piano, he asked what I would like to hear, and my request was “Some Enchanted Evening.”

As he sat on the bench and lifted the keyboard cover, he transformed before my eyes. Head high, shoulders back, he began one of the most beautiful renditions of the song I had ever heard. As the glorious music filled the community, Rudy drew quite a crowd that day and every day thereafter for the entire eight months he lived with us. He passed away in his sleep one night. Finding a list of songs next to his bedside that he was to play that day, I took great comfort in knowing he died doing what he loved to do.

For many of today’s seniors facing the prospect of moving to a senior living environment, the mere mention conjures up visions of nursing homes from yesteryear. Perhaps they had a parent, other relative, or friend who spent their last days in a facility that was cold, sterile, and known as a place where people go to die. Convincing your loved one otherwise can seem nearly impossible. However, look for the magic keys such as a well-stocked library, a community garden, a bible group, or a creative writing club to assist with opening their minds.

This experience also taught me the importance of developing and maintaining hobbies and interests early in life, as they may be what bring us the most comfort in our older years.

VA Benefits: Using Aid and Attendance to Pay Any Person for Care in the Home

Most people who have heard about Pension (Aid & Attendance) know that it will cover the costs of assisted living and, in some cases, cover nursing home costs as well. But the majority of those receiving long term care in this country are in their homes. Estimates are that approximately 70% to 80% of all long term care is being provided in the home. All of the information available about Pension overlooks the fact that this benefit should be used to pay for home care. Maybe if more people knew this fact, more people would be applying for the benefit.

It also comes as a surprise to most people that VA will allow veterans’ households to deduct the annual cost of paying any person such as family members, friends or hired help for care when calculating the Pension benefit. This annual cost is then used to calculate the benefit based on a new "countable income" and allows families earning more than the pension benefit to receive a disability income from VA. Read full article ...

Never Forget: USS New York

Built with 24 tons of scrap steel from the World Trade Center. It is the fifth in a new class of warship - designed for missions that include special operations against terrorists. It will carry a crew of 360 sailors and 700 combat-ready Marines to be delivered ashore by helicopters and assault craft.

Steel from the World Trade Center was melted down in a foundry in Amite, LA to cast the ship's bow section. When it was poured into the molds on Sept 9, 2003, 'those big rough steelworkers treated it with total reverence,' recalled Navy Capt. Kevin Wensing, who was there. 'It was a spiritual moment for everybody there.' Junior Chavers, foundry operations manager, said that when the trade center steel first arrived, he touched it with his hand and the 'hair on my neck stood up.' 'It had a big meaning to it for all of us,' he said. 'They knocked us down. They can't keep us down. We're going to be back.'

The ship's motto? 'Never Forget'

Eldercare Funding Part V: Long Term Care Insurance

by Patricia Grace

With Baby Boomers reaching retirement and Americans living longer than ever, Long Term Care Insurance (LTC) policies should be on the minds of many people, in particular those close to retiring and those who will need to take care of loved ones over a long period of time. Long Term Health Care Insurance protects you, as well as those you love, in the event that extended health care is needed in your lifetime. It also provides benefits in the event of a long-term illness or injury. Owning a long-term care insurance policy also provides you choices in deciding where or how you receive care. It helps pay for benefits for care that is delivered in your home, in the community, in adult day care centers, in assisted living communities, or in nursing facilities.

No one likes to think about long-term care. However chances are, one day; most of us will need it. In fact, according to the U.S. Department of Health and Human Services, 70% of people age 65 and older will use some form of long-term care services during their lives.

What is covered by Long Term Care Insurance?

Under almost all policies, coverage will kick in if you can’t perform certain activities of daily living — like walking, eating or bathing — because of a physical or cognitive impairment. Verify that the coverage will start if you can’t perform any one of the above activities — not necessarily all three. For example, someone may well be able to eat after they are too frail to walk or bath unassisted. Once a policyholder meets the definition of a triggering event, the kind of care that is covered varies widely.

Make sure that all types of care are covered- including nursing homes, assisted living and in-home personal care attendants. Most policies provide for all three types of care; however it’s important to make sure your policy does.

Claims have also been denied because insurers say a particular nursing home or other long-term care facility doesn’t qualify for coverage, leaving policyholders responsible for huge bills after they’ve already become a resident. Be sure to check that the policy you are considering doesn’t include overly narrow restrictions.

Who pays for long term care?

Many people are under the impression that Medicare, Medicaid or their health insurance will pay their Long Term Care costs…this is not correct!

• Medicare has eligibility requirements for skilled nursing care only and is for a limited time period.

• Medicaid is a welfare program. It will NOT cover long term health care costs for the average American.

• Health insurance and medical supplements DO NOT cover nursing home care.

• Individuals and families through their savings, assets, and cash pay most of the costs associated with long term care at home, in assisted living or in a nursing home.

Why should I have a long term care policy?

You are taking an important step towards securing the financial future for you and your family. Your greatest financial risk today and in the foreseeable future is not your hospital or doctor bills, but the very high cost of long term care.

• Over 40% of all Americans over the age of 65 will spend some time in a nursing home due to a prolonged illnesses or disability. Your risk of needing long term care is probably much greater than you realize. Assistance may be needed on a temporary or permanent basis for performing basic ADL’s such as bathing, dressing or toileting.

• Care might be provided in an assisted living facility, an adult day care center, a nursing facility or even at home.

• Once a patient reaches the arbitrary number of days in the hospital, Medicare payments stop regardless of the individual patient's actual condition or the need for continuing care. When Medicare payment stops, patients are released from the hospital as quickly as possible. Most patients must then finish their recovery from illness or injury in some type of nursing home facility, or, when possible, arrange for nursing medical services in their own homes.

Long term care and women

Why is long-term care a woman's issue? Simply put…women live longer than men. Women have higher rates of disability and chronic health problems. On average women outlive men by about five years and married women more often than not outlive their husbands. Women who reach age 65 can expect to live an average of 20 more years and those who reach age 75 an additional 13 years. A third of long-term care insurance claims begin between ages 70 and 79; over half (55%) begin after age 80. More than two-thirds of Americans age 85 or older are women. Eight out of 10 centenarians are women. Thus, women are far more likely to need long-term care insurance.

Reducing the cost of long term care insurance

Affordability is a vital ingredient in any successful long-term care insurance plan. And there are ways to help make this kind of insurance more affordable without sacrificing good coverage.
If you receive quotes from several highly rated insurers and yet find that the premiums are still too much to bear, there is no need to panic and assume that long-term care insurance costs too much. You may be able to adjust the benefit amounts of the original quotes to bring the premiums more in line with your expectations.

One way to lower premium costs is to make sure you know what the actual costs of care are in your area. There are many statistics used when discussing long-term care costs and often these are based on national averages. The actual cost of home care, assisted living facilities and nursing facilities in your particular area may be much lower.

You can find out what long-term care costs are locally by downloading the latest Genworth Cost of Care Guide or by calling a 2-3 local home care agencies and/or assisted living communities to request information on their daily/weekly/monthly rates. Another way to lower long-term care insurance premiums is to shorten the benefit period. Many consumers feel that having an unlimited benefit equates to better coverage. A recent study published by the American Association for Long-Term Care Insurance in their 2009 Sourcebook revealed that only eight percent of those who buy a three-year benefit period exhaust the policy and still need care. Only a little over one percent of those with a five-year benefit period will see their claims closed due to policy exhaustion. Lowering the benefit period can be a practical way to lower insurance costs without sacrificing vital coverage.

Another way to economize on long-term care insurance premiums is to increase the elimination period (the number of days after your care begins that precedes the insurance company’s first payment of claims). Almost ninety percent of individual long-term care insurance policies use an elimination period between ninety and one hundred days according to the same 2009 Sourcebook referenced above. If your initial quotes used a thirty-day or sixty-day elimination period, you may be able to significantly lower the premiums by choosing a ninety-day elimination period instead. However, it is important to make sure that you are able to pay the full cost of care during the elimination period. In the long run this option might not provide the savings that you are hoping to gain.

This article concludes the series on eldercare funding options. Hopefully, you now have a better understanding of the financial products available to meet the rising cost of long term care, while protecting your financial legacy.

Medicare Part - D Coverage Gap - Tis the Season

After spending their annual deductible, Medicare Part D enrollees pay 25% of the cost of medicine until they have spent the main benefit limit. At this point, participants are in the so-called "Donut Hole" coverage gap. In the gap, beneficiaries pay 100% of their medicine costs until they spend enough that Catastrophic coverage begins. Many seniors may never reach the catastrophic limit and will be paying 100% of their prescription costs for the remainder of the year. This is where the benefit of a free Prescription Drug Discount Program can take a bite out of the coverage gap.

The SilverGrace FREE Prescription Drug Discount Program provides discounts on drugs and other health care supplies at participating pharmacies. You can immediately save 10% to 85% on the cost of thousands of brand-name and generic prescriptions. Discounts average 15% for brand-name drugs and 46% for generics

There are no limits on medications, and you can use the card at more than 50,000 pharmacies nationwide. No enrollment is necessary. Simply present the card with a valid prescription at a participating pharmacy. The pharmacist will apply the discount, saving you money on the spot! One card can be used by your entire family. Print your card now