Short Term Careless

TOG has long term care insurance. It’s time - dear god it’s time - to file a claim. By which I mean it’s time for me to do all the work necessary to give TOG more money he can use to pay his rent. The man couldn’t do this for his demented mother, so it’s not like I expected him to do it for himself. I wonder what it would be like to have someone who would care for me?  I’m a fucking saint.

So, at my initiation, we met with the nurse at La Vida Loco who took five minutes to fill out a Resident Assessment saying TOG needs the minimal help with the minimal Activities of Daily Living to file a claim.  Then I called the insurance company who, by the way, has been nothing but responsive, professional and helpful so far. Our cheap policy however provides that it’s the insurance company, not the residential nurse or his primary care doc who determine TOG’s ability to not perform the ADLs. So, I’m a bit nervous. So, the following texts:

ME:  Set up appointment and put it on calendar for nurse from insurance company to come to your place to do evaluation. I’ll bring what we need.

WISIMH:  Like your prescription list, your diagnoses, your hospital stays, your durable power of attorney, the patient statement part of the claim form which I will will, of course, fill out and put a paper clip where you sign. You know, the stuff you could print out online from Kaiser or download from the shared files in the cloud. And also, this is the time when you tell me how much you appreciate all I’m doing for you here.

TOG:  Should I set something up for just us to talk with Darlene

WISIMH:  Thank me very much. I’m welcome. Darlene? Who the hell is Darlene?

ME:  Maybe. There is some legalese that might require the facility to cooperate. Let me scan the letter then I’ll email you w specific questions for her. Who is Darlene? Not D (the nurse) or M (the business office who will have to provide statements). What’s Darlene’s role here?

TOG:  Darlene schedules “help” she is also very familiar with ADL requirements and seemed to be helpful. I suggest you call her after you read the claim form.

WISIMH:  Of course I should call Darlene. Because not only can’t you set up this process, meet with the nurse or business officer, read the claim form – let alone complete it, you can’t be bothered to talk to Darlene who works in the fucking building where you fucking live. Too bad not being a lazy slug isn’t an ADL or you would have qualified in the last century and saved thousands in premiums. Not to mention all the Xanax I've had to take every time I come to visit you.

ME:  Then I won’t even bother to send you info if you don’t want to be the go-between. What’s her last name and title?

TOG: (crickets) (Although to be fair, it turns out he was driving his bike around his 700’sq apartment looking for her card. And which, if you saw what a mess he’s made in this tiny space without a personal assistant to file, put away stuff, close cupboard doors etc is pretty impressive, so no wonder it took 15 minutes for him to find Darlene’s card.)

ME: There’s also a form to be filled out by “Attending Physician”. The form says this is the doc that “best knows the insured’s condition”. Would that be Dr. P (who he saw once when he changed his primary care to the Kaiser office closer to La Vida Loco) or Dr. S (his long-time pulmonologist who knows he has about ¼ of the functioning lungs he needs).

TOG:  ‘qA

ME:  You’re a big fucking help. Just like your mother was.

TOG:  Disregard that qA. My doctor will be Dr. fat (The spellcheck is biased against Vietnamese surnames) is closest and he’s the general practitioner of need and those things other than just pulmonary stuff here’s the info about Darlene (attaches photo of her business card) Resident services supervisor assisted living.

WISIMH:  Thanks big guy. That’s the least you could do. Seriously.

So I sent e-mail to Darlene who actually replied in person to TOG saying she’d be around to advise but didn’t need to be at the insurance company nurse exam. I also called Dr. P and left message and was later told he’d need to see us in person to do an eval – never saw that coming – and so I made an appointment for that. 

                                                                         ***

Now, before sharing the next text conversation, a bit of backstory. La Vida Loco has a menu system for assisted living services with different levels/costs based on points assigned for each specific service. You get points for such services as standby assistance for dressing and bathing, dispensing meds, and graduated increases in services until they’re giving you the bath, spoon-feeding you, and checking on you several times a day because you can’t find the I’ve Fallen Button you wear on a chain around your neck and/or remember to push it when you fall.  The menu system is set up so that he pays $300 extra per month for the minimal assistance he needs, but there’s room in the points for them to, say, order his prescriptions for him, without exceeding the points that take the cost to the next level.

When I checked the menu and the costs - because I knew he wouldn't - I’d suggested he have them order his catheters at least since he’s paying them an amount that would include that service.  Because I suggested it, needless to say, he declined. Because he’s a stubborn old man, and President-for-Life of the Passive Aggressive Spouse Club. And because there's a game for that.

TOG:  I talked to Darlene and she says the nurse will do an evaluation and then give a questionnaire for Darlene to fill out.  She also suggested that we might consider adding more items up to the 59 point level. “You have a little wiggle room”

ME:  Which I suggested earlier…

WISIMH: … you idiot…

ME:  … You should print out a copy of your prescriptions including caths. Then ask if they can order them. Since you’re paying $300 you might as well get $300 worth of services.

WISIMH:  So, it was a good idea when Darlene suggested it. Now that I’ve concurred however, I’ve initiated the game. It's called You Make a Suggestion, Then If I Concur, You Reject It. I also taunted you by reminding you that I’d suggested that weeks ago. My Spidey-sense tells me you’ll decide against the prescription ordering service. Let’s see what happens next…

TOG:  Ok but I don’t think I can start any of this prior to tomorrow…

WISIMH:  TOG’s mission statement is “Why put off until tomorrow what you can put off until the day after that?”

TOG: …Also I’m wonder if checking O2 stats daily might be better than ordering meds.

WISIMH:  I Win! We both know that while TOG has seriously bad COPD, he converts oxygen (O2 stats measure that) at > 90% which is the cutoff for prescribing an oxygen tank. But if I remind him of that, I’m playing into his hands and he’ll find a reason why this isn’t such a good idea after all.  But I love the guy, what can I say?

ME:  Why not ask doc P or doc S. You can email Dr. S and ask if she thinks that might be worthwhile.

TOG:  K

WISIMH:  Yup. When you're too lazy to type the O in OK, what are the odds you'll follow up? My Spidey-sense is tingling again, feeling suspiciously like a pain in the back of my neck.