Refusing Medical Care Because of Money Worries

THE CLIENT’S SITUATION

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Donna’s  father, Neal, an 80-year old Korean War veteran, had been extraordinarily healthy throughout most of his retirement. However, lately, he had begun to suffer debilitating pain in his joints. First it was his knees, and he used a cane, but with his walking gait interrupted and being forced to lean over to one side while using the cane, he began to have pain in his back, knees, and shoulders.

Neal’s doctor advised him that he should consider knee replacements, which, after several months of rehabilitation and physical therapy, would likely result in him being entirely pain free and no longer needing his cane. The total costs would be in the neighborhood of $100,000.

Neal refused, saying he couldn’t afford it, despite the doctor’s assurances that the surgery and post op recovery would be covered by Medicare. “I don’t have Medicare,” Neal insisted.

PARAGON’S SOLUTION

Donna mentioned her worries and frustrations with her father during a normal progress meeting with PARAGON advisors - and we were immediately on alert. The behavior that Neal was displaying was unusual, but not particularly rare. Specially trained to deal with senior issues, and with specific designations helping us to to understand problem areas, we suspected that Neal simply did not understand his health insurance. We asked Donna to bring Neal by the office for a chat.

It turned out that Neal had employer-provided retiree insurance, and the premiums were automatically taken out of his monthly pension payments.  Over time, like many seniors, Neal had forgotten the details of how his health insurance worked.

A phone call to Neal’s insurance company, with Neal on the line, provided the answers. Neal’s policy was a “Medicare PPO” plan – a plan which operates within the constraints of Medicare, but does not “look or feel” like typical Medicare.  Neal did not have a Medicare card like his friends did, and, because of the situation, actually thought that he did not have Medicare coverage and would have to pay for the surgery out of pocket. As it turned out, Neal’s insurance was very good, and the expected out of pocket cost for him to have both of his knees replaced would be about $1500 – easily affordable for him.

Having extensive training and experience working with seniors, the PARAGON team is constantly on the lookout for issues like these.  It is not uncommon for seniors to forget details about their finances – including monthly cash flow, periodic deposits, large accounts that are “out of sight, out of mind,” required minimum distributions from IRA’s and 401k’s, and the nuances of health insurance coverage.

These tendencies make seniors particularly vulnerable to elder abuse – both from outside parties, as well as from family members.  As we consider our clients a part of our PARAGON family, we are ever vigilant for issues that may endanger or harm our valued senior clients, and respond appropriately within the constraints of the law and current public policy. They deserve no less.

VALUE TO THE CLIENT

Once he understood his health insurance coverage, Neal decided to have the recommended surgeries. After several months of physical therapy, he was up and around and enjoying his new, pain-free mobility. As predicted, the pain in his hips and back went away.  Neal still lives independently, in his own home, today – over a decade later.

Jonathan Darabos