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toodles04
Contributor ⭐
May 26, 2023

Financial Exploitation of a 99 1/2 year old woman on Hospice care, by AARP United Health Care plans

  • May 26, 2023
  • 8 replies
  • 6430 views

I have a long and painful story about my mother, now deceased as of 4/22/2023, who was financially exploited (qualifying as elder abuse) by AARP's United Health Care plans - both supplemental insurance and prescription insurance.  To whom in the system should I address my complaint?  

 

Thank you, 

Dr. Shelley P. Caswell-Moore

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    8 replies

    GailL1
    May 26, 2023

    You have to give details - because I think this is a dangerous claim without giving details.  

     

    Medicare (Part A) covers ALL of Hospice care - with a small copay for meds - like $ 5.00.  In fact, not even a Medigap plan has to pay any for Hospice care since it is covered at 100% rate by Medicare.

    Now it is important to understand exactly what Hospice is - it is a defined coverage item.  Things outside of it, if medically necessary that is covered by Traditional Medicare + Medigap are still covered as long as they don’t relate or conflict to the Hospice coverage.

    Maybe it would help to read up on Medicare Hospice - a few links

     

    Medicare.gov - Hospice Care Coverage

     

    Medicare.gov - Medicare Hospice Benefit

     

    Medicare.gov - How Hospice Works 

    To answer your specific question 

    If the links don’t give you a solution - address your concerns to UHC cause AARP is not involved in the actual insurance - they only sell their branded name for financial support of their programs.  

     

     

    toodles04Author
    Contributor ⭐
    May 26, 2023

    The issue has nothing to do with Medicare or Hospice. The problem is that my mother tried numerous times via snail mail, fax, and phone, to cancel both her UHC plans due to the coverage she had with Hospice and knowing she wasn't going to need/use anything else. We have a paper trail of her attempts, and for months, she continued to get billing statements. Every month she wrote back saying she had canceled, providing her documentation. Each month, UHC wrote her back acknowledging that she was trying to cancel and each month giving her a different explanation of what she had "done wrong." She tried her best - she was hard-of-hearing, old, frail, and dying. But she was cognitively intact and knew exactly what she was doing. Where is the advocacy for our venerable older adult population in this scenario?  Where is the compassion?  What kind of customer service is this? 

     

    As recently as yesterday, my sister (Executor) spent 6 hours on the phone with UHC being given the "run-around" just like our mom had been given.  At one point, while my sister was on hold, UHC turned this $309 bill over to a collection agency!!  Where is the respect and understanding for a nonagenerian (almost 100 years old) who had, in all good faith tried to cx her coverage to save money as many people on fixed incomes would do? 

     

    This is surely UHC's business, but we have already tried talking to them.  AARP endorses UHC plans - it is right on all the literature and insurance cards. 

     

    As a gerontology professor, I can assure you that this kind of treatment for a 99 1/2 year old American, is reprehensible at best.  The family feels that our mother was taken advantage of due to her age and frail condition and that she was mistreated by a large organization that is supposed to be a friend and advocate for older adults. 

    GailL1
    June 5, 2023

    @toodles04 

    Let’s look at these different coverages - one by one.

    1.  Supplemental Medicare coverage - a/k/a MEDIGAP”. 

    This is NOT health insurance - it is a financial insurance product sold by insurance companies which is GAP insurance - depending upon the Medigap plan which she picked and paid monthly premiums - it picks up any approved Medicare coverage cost to the insurer - her out of pocket expenses.

     

    ALL she had to do to cancel a Medigap policy is to tell the insurer to cancel it - or stop making the monthly premium payment and they would stop coverage.

     

    2.  Prescription Drug Coverage - she had to keep this because she probably had some meds or could have in her last days to make the “comfort” easier - be that pain meds or anxiety meds and perhaps others.  

    Also it she was on some maintenance meds like insulin, high BP, cardiovascular - those would continue UNLESS the doctor removed her - and that is most unlikely especially for things like insulin which withdrawal from it could cause immediate death -   That’s not how doc’s work.

     

    Even if Medicare under the Hospice benefit is paying for most of her meds except the $ 5.00 copayment - that does not mean that the prescription drug company isn’t still paying their share of the WHOLE cost of the meds to cover them.

     

    So if she had successfully cancelled her Part D Prescription Drug Coverage - she would have had to pay MORE for any meds she was getting or might get in Hospice than the $ 5.00 co pay.

     

    I am hoping that these were the Medicare free-standing plans that she was on - Traditional Medicare, Medigap + a free-standing Medicare Part D plan for prescription drugs.

     

    Medicare does NOT look at the age of any patient - that does not play into any benefits inclusion.  

     

    Some people go in and out of Medicare Hospice care sometimes. 

    Some people have something come up that isn’t covered by Hospice - I gave you an example of a bone break which could always happen - This would not be covered by hospice and would still have to be treated - and if she had cancelled these other parts of her Medicare coverage - she would have had to pay ALL of her out of pocket cost - treatment and Medicine cost - 

     

    Medicare is insurance - Insurance is congregate coverage - everybody pays in to get the benefits - It has little to do with compassion - this is insurance / money of which it is a system for over 60 million people.

     

    I am sorry for your loss - 

     

    One more caveat - now if your mother had a Medicare Advantage plan with a built-in prescription drug coverage instead of traditional Medicare + Medigap + free-standing Medicare prescription drug plan as I have described above - the end results would have been the same but just under different rules and insurance payers.  Some folks that don’t know how Medicare works and the choices one has under the program, sometimes confuse the different plans.

     

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