In which Dad & I continue our education regarding corporate health care.
Dad likes doctors who speak plainly to him. It’s a big part of what he likes about Dr. Primary (his primary care doctor), Dr. Pisser (his urologist), Dr. Onco (his oncologist), Dr. Tootsie (his podiatrist), and even Dr. Twitchy (his neurologist). In fact all of these doctors have been specifically chosen as much for their ability to communicate with Dad as for their medical skills.
Not actually Dr. Primary
So it was actually a bit of a relief to Dad when Dr. Primary told him “you probably won’t see Christmas this year.” It can’t be put much more plainly than that. Dr. Primary also suggested that it was time that we got Dad into a hospice program.
Now, since we’ve been through this once before with in-home care (you can read all about that thrilling episode here), we knew that Dr. Primary would refer us to Dr. Asshat’s Lying Thieving Hopsice Company. And sure enough, as we walked out of the office Miss Useful (the scheduler) offered to set us up for an “intake visit” from Dr. Asshat’s Lying Thieving Hospice Company. I nearly declined on the spot, since I knew that there was no way we would be using
This may actually be Dr. Asshat
Dr. Asshat’s Lying Thieving Hospice Company. But then again I thought, why not waste some of their time – and they may provide a useful comparison point. So we set up the visit with Dr. Asshat’s Lying Thieving Hospice Company.
As soon as we got home, I googled up other hospice companies in our area. I decided that Happy Hospice company looked like a good candidate, so I called Miss Useful (and only had to talk to 5 of the Useless C’s before I could talk to her) and asked her to also set up an “intake visit” with Happy Hospice.
Now the fun begins! Miss Useful informs me that it isn’t usually
The Tree of Hospice Caring
done this way. Usually she only writes one referral and that is the company that we would use. This of course pisses me off. So I bluff. I remind her that the law requires her to write the referral to whatever agency or agencies that WE choose (I have no idea if this is true or not – but it worked)! So she backs off and does what I asked. Score one for the home team.
The visit with the woman from Lying Thieving Hospice Co. actually goes pretty smoothly and even starts on time. She paints a wonderful picture of the caring team of professionals who would look out for Dad’s best interest for the remainder of his life. She assures me that that the Lying Thieving Hospice Company is nothing like those lying thieving bastards at the Lying Thieving Nursing Company. Even though Dr. Asshat is the “Medical Director” for both firms, she assures me that they are nothing alike. I give her all of Dad’s information, including his list of medications. She looks it all over, declares that everything is wonderful – and if Dad will just sign on the dotted line we can start making the magic happen.
The happy picture of a caring hospice worker
Of course she is very unhappy when I tell her that we will also be hearing the sales pitch from the Happy Hospice Company and that we won’t be signing anything until after we evaluate our options. She has “never heard of such a thing” and leaves in a bit of a huff.
The following day we get our visit from the Happy Hospice Company. Five minutes before the scheduled time, this woman calls us and tells us that she will be running half an hour late. She doesn’t ask if that will be O.K. with us – she just informs us that she’ll be late. She arrives at T+30, and proceeds to spend the next 10 minutes talking on her cell phone in the driveway. She then comes in and informs us that we’ll get started as soon as the nurse arrives. At T+60 the nurse arrives. I inform them that this is a bad sign, if they can’t be on time when they are trying to sell us their services, how are they going to treat us after we’ve signed up? She informs me that this is not a sales call, it is an “intake visit” and the purpose of the visit is to sign us up and get the service started. I’m not sure how that is actually different from a sales call, but whatever.
I’ll give the Happy Hospice Co. nurse credit. She looks over Dad’s list of medications (the same list that I provided to the Lying Thieving Hospice Co. worker) and informs us that we will “of course have to discontinue the Zometa.”
Zometa - it builds strong bones
Zometa is a drug that Dad gets through an IV once a month. It doesn’t actually do anything with regards to the cancer cells that are rampaging through Dad’s blood stream. What it does is strengthen Dad’s bones so that they are better able to resist the cancer cells from eating away his bones or setting up housekeeping in his bones. It is good to keep the cancer out of the bones, as it can be VERY painful if the cancer metastasizes in the bone.
This is a very expensive medication – about $1,200 per treatment. But as we’ve previously covered, Dad has great insurance that pays for this treatment. I explain to the Happy Hospice nurse that Dad’s insurance will cover the treatment, so we don’t see any need to stop it.
And this is where I get my next lesson in the business of health care. The nurse explains to me that once Dad enters into a hospice program, Medicare picks up all of the costs. However, any Medicare supplement that you have will no longer cover any treatment related to whatever caused you to enter hospice.
At this point I decide that we need to regroup and study the situation some more. So I send the ladies from the Happy Hospice Company on their way (they too are disappointed that we won’t sign anything) and start researching some more.
This issue is particularly troubling to me, since the Lying Thieving Hospice Co. didn’t seem to have any issue with Dad remaining on the Zometa. But, as their name implies, the Lying Thieving Hospice Co. isn’t exactly known for their honesty. So I call them up and ask specifically about Dad’s Zometa treatment. The charming and delightful person at the Lying Thieving Hospice Co. informs me that “of course he’ll have to stop the Zometa, it isn’t covered.” Wow! It sure would be nice of them to tell us that before they ask us to sign on the bottom line. They decide that they should schedule Dr. Asshat himself to come to our house the next day to explain it to me.
In the meantime I do some more research. The nurse from the Happy Hospice Company was telling the truth – as far as she went. Of course she didn’t tell the whole truth.
Hospice Mission Statement
“Standard” hospice companies work exactly as she explained. When you enter hospice, Medicare takes over the complete cost of hospice. Any Medicare supplement that you happen to have is no longer in effect for the disease that caused you to enter hospice. And since standard Medicare doesn’t cover Zometa, you can’t have it if you are in a “standard” hospice program. Actually that isn’t entirely true – the “standard” hospice company could still let you have the treatment. But Medicare won’t reimburse them for the cost of the treatment. So the hospice company would have to pay for it out of the per diem that Medicare pays them for everyday that you are in the program. But since this would cut into the profit margins, no “standard” hospice program will let you have the treatment. Remember, it isn’t about the quality of care or quality of life – it is all about the profit margins!
But my research tells me that if you select an “open access” hospice program instead of a “standard” hospice program – you get to keep your insurance! This sounds like what we need. In fact, it sounds like how hospice should work.
A Common Insurance for Hospice Patients
Most people who need hospice care, I’m assuming, are on Medicare already. And if they are smart or fortunate, they have a Medicare supplement. So why would you not be able to use your Medicare supplement to help pay for medical care that you want or need? Can anybody explain this? How does this make sense?
The following day, Dr. Asshat arrives to explain things to us. First, he explains that while Dad cannot have further Zometa treatments, there are oral medications that work “almost as well” that he could still receive from the Lying Thieving Hospice Company. Then he proceeds to tell us that Zometa is “a bad medication for your father.”
Now hold up there a minute doc! If Zometa is a “bad medication” then why would we want an oral substitute that works “almost as well?” Would “almost as well” mean “not quite as bad?” What are you talking about? I held that thought and instead asked “Why does Dr. Onco keep him on the treatment if it is a bad medication?”
Dr. Asshat’s well thought out answer to my question was simply “I’m not going to argue the literature with you, you wouldn’t understand anyway.” EXCUSE ME! EXCUSE F’n ME! Who do you think you are?
But I knew that open rage wouldn’t really help Dad, so I managed to hold my tongue for a change and instead asked about “open access hospice.” You know, the kind of hospice where Dad could still use his insurance to pay for the Zometa treatments? Dr. Asshat, in his eternal wisdom says “I’ve never heard of that. I don’t believe that anybody would actually do that. It would be illegal.”
I don't know doc, can we look here?
Now I’m not a doctor with a degree. I probably don’t understand “the literature.” I’m not the Medical Director of two different Lying Thieving health care companies. But I do know how to use Google. You, gentle reader, probably do too. So go ahead, google up “open access hospice” and see what you can find. That’s right, you’ll find literally hundreds of “open access” hospice companies. Apparently they are all illegal, if you believe that Dr. Asshat has a clue.
We have since regrouped, and located three different open access hospice companies that service our area. We have interviewed the first of the three already, and we were very impressed. Keep your fingers crossed for us in this search.
And here are some tips and tricks if you need to find hospice care for yourself or a loved one.
* Read up on everything you can about hospice. There are reportedly lots of good hospice companies, and I can tell you first hand that there are lots of bad ones.
* Use your yellow pages. Google only gave me two hospice companies that serve our area – Lying Thieving Hospice & Happy Hospice. The yellow pages gave me five companies.
* If you have a Medicare supplement, or other private insurance, you REALLY want to find an open access hospice company. DO NOT settle for anything else. You have insurance, you should be able to use it.
* Check, double check, and triple check EVERYTHING. These companies will do or say anything to get your business. Do not simply trust the referral from your doctors office. There are lots of options – find the best one for you and your loved ones.
* Make sure that the hospice company that you select provides an emergency kit of some sort. This emergency kit usually contains medications to ease breathing and manage pain. They often include some form of morphine. This kit could be a big time blessing in the case of emergency pain. Do you really want to wait half an hour for the nurse to arrive, or do you want to (at their direction) get your loved one some relief NOW? Believe it or not, not every hospice supplies such a kit. Make sure that yours does, and make sure that you know what is in it.
* During the sales call (or even before if possible) provide the hospice company with a complete list of medications. Make sure that they understand and verify YOUR desires with regards to current medications. YOU must dictate to them, do not let them dictate to you!
* There are lots of good websites that give suggestions about choosing a hospice provider. None of them that I’ve found mention “open access.” But they do have lots of good ideas. Read them all! This is a very important decision. Make it carefully.
As usual, the names of the health care providers & companies have been changed mostly for my amusement. If you want to know any of their real names, e-mail me privately.
Prop It Up