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Hi - My dad will be 90 in January. This past year he was in the hospital 4 times. Hee had 3 ambulance trips, and a bunch of doctor's visits.

Of course, we have been inundated with bills. He has no income besides SS. He doesn't own any property, and his only assets are about $3000 in the bank, and a car with 165,000 miles on it that currently cannot pass a safety inspection. He also has a $5000 VA death benefit policy.

I should also point out that he cannot cook for himself, drive himself, or be alone anymore. Anytime I am not able to be there, he has to hire paid help. The costs for restaurants / caregivers/ companions/ transportation have left us shellshocked. He is spending $1000 plus most weeks, including his many medications, and has depleted his savings.

At the advice of friends he has been paying each of his creditors at least $10 a month. Many of the smaller bills have been paid off. Most of the larger creditors have been fine with it, too. They understand he is on a fixed income and know he has been very ill.

Two of them though, have been a big problem. The first is an ambulance company that took my father 3 miles from his doctor to the hospital. From what I can tell they were paid about $550 by insurance and billed my dad an additional $167. They demanded immediate payment in full, when I asked them to send me a breakdown of the costs, and why it was so much?, they immediately sent to collections.

The second is a hospital. They have sent as many as seven separate bills in a month. My dad has paid $10 on each one, two have been paid off. The remainder total about $850, I'm guessing, because when I called them they would not verify that there will be no additional bills pending...

So, I told them about my dad's finances, and that he could continue to pay $10/month on each of the outstanding bills, and that would be $40 a month total.
Nope. They threatened collections. They don't seem to understand that he owes money to numerous other doctors and services too. They just want all theirs NOW.

My dad needs a hospital bed, and other things for six months now. His doctor has tried to get insurance to approve them, they keep saying they "aren't medically necessary." The cost for everything would be at least $8000. My dad is very uncomfortable and hardly can get any sleep because of COPD and pain, but he is willing to without the bed and other things because he is trying to pay all of his creditors. He has even asked me to sell his car, or offer it to the hospital to settle his bills there.

I don't know what to do. I am already supporting him as much as I can, or he would have NO money for these bills. My friend tells me that if the hospital sends him to collections he should refuse any further payment and work on the bills that aren't in collections, so his credit doesn't get dinged any worse? I have no idea what to do any longer.

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A couple of things.

Have you applied for Medicaid for your dad? It sounds as though he would be eligible. Going forward, that would pay his hospital and ambulance bills, prescriptions and might cover some home care services. Get started on the application today.

Has his doctor written a precription for the hospital bed? That's who needs to say that it's medically necessary. Call his doctor today. And get the doctor to scrpt some home care.

I would also find an eldercare lawyer who will give you a free " first consultation" to advise on the bills.

More folks will be along with more advice, I'm sure.
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Erwin does dad's credit rating really matter at this point? Stop paying the creditors, they can't get blood out of a stone. There is a way to stop them harassing him but I don't know how to do that but maybe someone else may.
Change the Dr and find one who is more tuned into the elderly. Contact your local area on aging and ask for help getting Medicaid. It certainly sounds as though it is time for Dad to be in some kind of sheltered facility. next time he has to be in the hospital get them to refer him for nursing home care and request the social worker assist with medicaid application. many nursing homes will accept a patient "Medicaid pending" Public health may also be able to help get him situated. Good idea to consult legal aid. Can you stop enabling him by buying essentials while he is paying on these bills. Chances are that if you do succeed in getting a hospital bed he will refuse to use it. I think he would be most comfortable sleeping in a recliner. you can probably find a good used one. If a hospital bed is essential The American Legion often has a free loan program and they will usually lend to anyone not just veterans. You can also try and advertise in your local paper. You may get one for around $100, same with a recliner or any other equipment you may need. If you belong to a church people there may know of one you can borrow or buy. There are lots of options you just have to get creative. Moving him into your home will probably not be a good idea as many have found out.
We have a Medicare PPO which costs $150 a month but the copays are still quite high, However last year hospitals billed almost a million for three months i spent in a couple of hospitals. Research cheaper alternative for expensive medications or odrer them from Canada or elsewhere.
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What are your plans for his living situation? since it doesn't sound like he can afford to continue to pay caregivers is it time to consider a Medicaid facility ?

This must be so hard for you - I'm sorry
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Erwin,

1. Is your father getting any assistance from the VA? If not, consider contacting a local VFW or American Legion post, or go directly to the VA or one of the county VA services to apply for medical assistance. If he has a service connected disability, apply for that as well.

2. I suspect your father doesn't have a supplemental insurance to pay the portion which Medicare doesn't pay. We have Medigap plans, which pay the "gap" portion, the 20% that Medicare doesn't pay. Other than direct pay for lotions and some assistive devices, all our bills have been paid by the Medigap plan.

This is the time to research the plans and decide on one before (I believe) Dec. 7, the end of the choice change period.

3. I hesitate to suggest this but perhaps bankruptcy should be considered. I don't know how changes in the bankruptcy laws as a consequence of the real estate recession might affect medical payments, but it's worth a consideration.

4. I would take a second look at the outside agencies that are providing about $1K weekly in expenses.

a. Check out paratransit options through the local public transit agency; it's cheaper than by ambulance/ambulette.

b. Consider getting Medicare Part D to provide assistance with meds; also contact the manufacturers/pharmaceutical companies directly to see if they have low income plans - that would reduce the cost somewhat if he qualifies.

c. Consider getting Meals on Wheels; the meals aren't restaurant quality, but they're also not restaurant priced. We pay $3 for a packaged meal, with a well balanced meal and sides. Meals can be ordered for the weekend as well.

d. Cook in big batches, pack in microwaveable containers if you have them. Your father can just microwave the meals; that'll save you some time in going over to cook for him.

e. Check out food pantries and see if he can get free food - canned goods, etc. Check with local bakeries to see if they have surplus outlets. In our area bread that's perhaps a day or two days old can be purchased for about 1/3 to 1/2 of the store cost.

4. Contact your county and state offices and see if they have elder law agencies. Michigan has an Elder Law organization which provides information on various assistances available for seniors - ranging from food to utilities.

5. Also contact the local senior center in your community to find out what they offer.

I think you could bring down that $1K weekly cost if you can tap into some of these local resources.
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Ervin, I'm going to suggest you apply to medicaid again. If he gets denied, you want to know specifically, does he have too much in assets, or in income. In most states, youu need to have less than $2000. In assets. Income limit varies by state.

If his income is too high, you can visit an eldercare lawyer and do what's called a Miller trust. Also, find out if dad qualifies for any Medicaid waiver programs which might provide some home care.

Find out if Medicaid covers Assisted Living in your state, not hust nursing homes.
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One thought...see if you can pay the neighbor lady to do some casseroles frozen as individual servings. If she can do a week or two at a time, might be a good thing.
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Erwin, how does your Dad feel about Chinese food, or has he ever tried it? In my area we have a wonderful inexpensive carry-out with variety of food, and the food is very good. To cut down on the salt, ask for very little sauce.

My parents [in their 90's] never had Chinese food until I bought some home for them to try. At first my Mom was very leery of it, but once she tried it she was surprised. My Dad finished his whole plate :)
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Does your dad have Medicare Part B? Is that the insurance that you refer to with regard to the hospital bed?
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Another thought: check your local Area Agency on Aging and find out if it, or any agencies of which it might be aware, have loan closets. You might be able to get some of the assistive items you need on loan instead of having to pay for them.

Some Senior Centers have loan closets as well; check with the more upscale ones - in our area, they're the ones that have the best selections.
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Thank you - everyone!

I have made some progress with dad the past few days. He agreed to accept a recliner instead of a medical bed, and it has eased some of his complaints the last two nights.

I was also given a number for the transportation service. I spoke to someone there who said they don't know if they serve this area, but they are going to get back to me next week. I hope they do - it is $1.00 each way to WalMart! I can't do better driving him myself.

I had NO IDEA the VA covered any part of transportation costs - and I had asked! So thank you on that!!! You BET I WILL ask them again. If they paid even half of what it costs my dad to get there it would be a HUGE relief.

Regarding the food, he is adamant he will not eat food that he doesn't like. He will eat the casseroles that one of my friend's mom makes, oddly enough, because it reminds him of my mom's cooking. Go figure...

Insofar as the rest of it goes, he is pretty stubborn, mainly because he feels he been treated unfairly. He tells me that he had worked at five "good jobs" in his life. From these, he had earned two pensions and one 401K. The 401K, and my parent's retirement savings were wiped out when my mom had a heart attack.

The two pensions were raided by management under guise of a court order supposedly to ensure the companies stayed open - they both closed. He is extremely bitter about what he considers outright theft.

When I spoke to him about his bills, he pointed out that he has paid several of them off already, and despite his age and illness has been paying everyone. In his opinion, if they want their money faster - too bad. He also tells me that his car, and his death benefit should handle any unpaid bills upon his death.

He told me more, but I'll post that later. I'm getting tired.
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