Dear Savvy Senior, How do I go about appealing Medicare when they won’t pay for something that they covered in...
As I watch the number of older couples on our cruise, I am curious as to where they are from, if this their fi...
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Dear Savvy Senior, How do I go about making a family health history? Most of my relatives have died before age...
Second hospital in U.S. to achieve TAVR certification HCA Healthcare/Health ONE’s The Medical Center of Aurora...
SUBMITTED BY FAMILY FEATURES Making time to enjoy the outdoors is a simple way to boost your physical and ment...
In his best-selling book entitled, Bowling Alone, Robert Putnam outlines that social capital and civic engagem...
Dear Savvy Senior, Because of my mobility problems, I’m thinking about getting a walk-in bathtub that’s easy t...
BY BOB SWEENEYPUBLISHER The second annual CSU “Water in the West” Symposium showcased water and the use of wat...
BY FREDA MIKLINGOVERNMENTAL REPORTER Every November, Denver South Economic Development Partnership holds its a...
Dear Savvy Senior,
How do I go about appealing Medicare when they won’t pay for something that they covered in the past?
If you disagree with a coverage or payment decision made by Medicare, you can appeal, and you’ll be happy to know that around half of all appeals are successful, so it’s definitely worth your time.
But before going that route, talk with the doctor, hospital and Medicare to see if you can spot the problem and resubmit the claim. Some denials are caused by simple billing code errors by the doctor’s office or hospital. If, however, that doesn’t fix the problem, here’s how you appeal.
Original Medicare Appeals
If you have original Medicare, start with your quarterly Medicare Summary Notice (MSN). This statement will list all the services, supplies and equipment billed to Medicare for your medical treatment and will tell you why a claim was denied. You can also check your Medicare claims early online at MyMedicare.gov, or by calling Medicare at 800-633-4227.
There are five levels of appeals for original Medicare, although you can initiate a fast-track consideration for ongoing care, such as rehabilitation. Most people have to go through several levels to get a denial overturned.
You have 120 days after receiving the MSN to request a “redetermination” by a Medicare contractor, who reviews the claim. Circle the items you’re disputing on the MSN, provide an explanation of why you believe the denial should be reversed, and include any supporting documents like a letter from the doctor or hospital explaining why the charge should be covered. Then send it to the address on the form.
You can also use the Medicare Redetermination Form. See CMS.gov/Medicare/CMS-Forms/CMS-Forms/downloads/CMS20027.pdf to download it or call 800-633-4227 to request a copy by mail.
The contractor will usually decide within 60 days after receiving your request. If your request is denied, you can request for “reconsideration” from a different claims reviewer and submit additional evidence.
A denial at this level ends the matter, unless the charges in dispute are at least $160 in 2019. In that case, you can request a hearing with an administrative law judge. The hearing is usually held by videoconference or teleconference.
If you have to go to the next level, you can appeal to the Medicare Appeals Council. Then, for claims of at least $1,630 in 2019, the final level of appeals is judicial review in U.S. District Court.
Advantage and Part D Appeals
If you’re enrolled in a Medicare Advantage health plan or Part D prescription drug plan the appeals process is slightly different. With these plans you have only 60 days to initiate an appeal. And in both cases, you must start by appealing directly to the private insurance plan, rather than to Medicare.
If you think that your plan’s refusal is jeopardizing your health, you can ask for a “fast decision,” where a Part D insurer must respond within 24 hours, and Medicare Advantage health plan must provide an answer within 72 hours.
If you disagree with your plan’s decision, you can file an appeal, which like original Medicare, has five levels. If you disagree with a decision made at any level, you can appeal to the next level.
For more information, along with step-by-step procedures on how to make an appeal, visit Medicare.gov and click on the “Claims & Appeals” tab at the top of the page.
If you need some help contact your State Health Insurance Assistance Program (SHIP), which has counselors that can help you understand the billing process and even file your appeal for you for free. To locate your local SHIP, visit ShiptaCenter.org or call 877-839-2675. The Medicare Rights Center also offers free phone counseling at 800-333-4114.
As I watch the number of older couples on our cruise, I am curious as to where they are from, if this their first cruise, how long they have been married, and what keeps them together? Some of them are in scooters or wheelchairs, others are physically impaired either with walking difficulties or are very out of shape. Others have lost their youthful appearance and are no longer attractive but still, there is loving activity between these life-mates. What is the secret to staying in love? Is it the rhythm these couples have established over the years? Is it the many memories of building a life together? Is it the sacrifices they have made for one another? Is it the combined finances and the service they have given?
Talking with couples, it is all of it. Some have been retired for years and spend every waking minute together. Many have shared hopes to travel the world and be introduced to other cultures. Others have shared interests and recreational similarities playing golf or cards, doing puzzles, or playing Yahtzee or dominos. Many share a love for reading and trivia. It is fun to observe them. It is a sharp contrast to what I usually see in modern relationships. Commitment is a word that does not have a shared meaning in the culture. Building a life together, no matter what, is less appealing to this generation. Millennials get married less and live together more, swapping partners on average (according to research) every three years. Is this the new normal?
When I teach adolescents, I ask them what they are committed to. Many give me a “deer in the headlights” look. I ask if they are committed to breathing. Of course, they are. They would fight if anyone tried to take away their ability to breathe. Then I ask if they are committed to brushing their teeth, eating well, serving others, being kind? What about doing well in school, honoring their parents, staying away from high risk behaviors or winning a game?
Commitment needs to be operationalized as to its deepest meaning and taught in a way that makes it relevant when things, including relationships, appear to be disposable. Commitment builders include shared positive experiences, making memories and dedication to humor and flexibility. Brene’ Brown, in her best-selling book, Dare to Lead, talks about staying in the arena, being “all in” even when things are a struggle. Other commitment builders are thinking about what makes your partner happy or ways to improve the relationship, letting your beloved know how important they are to you. Listening more and speaking less. Expressing the desire to know what is on the heart of your partner is a way to develop intimacy and closeness. To stay committed to your loved one, we must work hard to stay away from temptations. We must build a wall around our relationship that does not allow anyone else in. This is a distraction that will tear the relationship apart. Commitment is promise and a pledge. When we commit, let’s be “all in”. firstname.lastname@example.org; www.myrelationshipcenter.org
How do I go about making a family health history? Most of my relatives have died before age 65, so my doctor recently suggested I create a family history to help identify my own genetic vulnerabilities.
This is a very good idea. An accurate family health history remains one of the most important tools in keeping yourself healthy as you age, and the holidays when family members come together is a great time to do it. Here’s what you should know, along with some tips and tools to help you create one.
Know Your Genes
Just as you can inherit your father’s height or your mother’s eye color, you can also inherit their genetic risk for diseases like cancer, diabetes, heart disease and more. If one generation of a family has high blood pressure, for example, it is not unusual for the next generation to have it too. Therefore, tracing the illnesses suffered by your relatives can help you and your doctor predict the disorders you may be at risk for, so you can take action to keep yourself healthy.
To create a family health history, you’ll need to start by collecting some basic medical information on your first-degree relatives including your parents, siblings and children. Then move on to your grandparents, aunts, uncles and first cousins.
You need to get the specific ages of when they developed health problems like heart disease, cancer, diabetes, arthritis, dementia, depression, etc. If family members are deceased, you need to know when and how they died. If possible, include lifestyle information as well, such as diet, exercise, smoking and alcohol use.
Some relatives may not want to share their medical histories, or they may not know their family history, but whatever information you discover will be helpful.
To get information on diseased relatives, get a copy of their death certificate. This will list their cause of death and the age he or she died. To get a death certificate, contact the vital records office in the state where your relative died, or go to VitalChek.com.
Or, if you were adopted, the National Foster Care & Adoption Directory Search (see ChildWelfare.gov/nfcad) may be able to help you locate your birth parents so you can get their medical history.
To get help putting together your family health history, the U.S. Surgeon General created a free web-based tool called “My Family Health Portrait” (see phgkb.cdc.gov/FHH/html) that can help you collect, organize and understand your genetic risks and even share the information with your family members and doctors.
Another good resource that provides similar assistance is the Genetic Alliance’s online tool called “Does It Run In the Family.” At FamilyHealthHistory.org you can create a customized guide on your family health history for free.
Handling the Results
If you uncover some serious health risks that run in your family, don’t despair. While you can’t change your genes, you can change your habits to increase your chances of a healthy future. By eating a healthy diet, exercising and not smoking, you can offset and sometimes even neutralize your genetic vulnerabilities. This is especially true for heart disease, stroke, type-2 diabetes and osteoporosis.
A family medical history can also alert you to get early and frequent screening tests, which can help detect other problems (high blood pressure, high cholesterol, and cancers like breast, ovarian, prostrate and colon cancer) in their early stages when they’re most treatable.
HCA Healthcare/Health ONE’s The Medical Center of Aurora (TMCA) announced the achievement of Transcatheter Valve Certification from the American College (ACC). The ACC has validated the program’s exceptional approach, including physician leadership, quality outcomes and team based clinical decision-making and care. TMCA’s TAVR program is the first in Denver and the Rocky Mountain Region, and the second in the nation, to achieve this official Certification.
The ACC’s Transcatheter Valve Certification is an external review and certification process that pairs with established national clinical databases to monitor patient safety and real-world outcomes related to transcatheter valve therapies. The certification uses established national clinical measures to support clinical decisions and links process improvement to patient outcomes. Hospitals that achieve Transcatheter Valve Certification are currently implementing best practices for evidence-based medicine to support patient-centered decision-making and can track key performance metrics to better identify opportunities for improvement. “The Medical Center of Aurora has demonstrated its commitment to providing the region with excellent heart care,” said Phillip D. Levy, MD, FACC, chair of the ACC Accreditation Management Board. “ACC Accreditation Services is proud to award The Medical Center of Aurora with Transcatheter Valve Certification.”
Using a patient-centric philosophy, the multidisciplinary team of board certified cardiologists, cardiac surgeons, cardiac imaging specialist, and specialized advanced practice providers, employ a collaborative team-based approach to treating heart valve disorders. Our unique process provides a patient with heart valve disorders, who may be candidates for transcatheter or surgical repair or replacement, to be seen in the TMCA Valve and Structural Heart Clinic, where a personal touch is delivered by a dedicated team to help navigate the procedural process and post procedural care. TMCA’s physicians are trained to use state-of-the-art techniques and devices, such as a Cerebral Protection System, to minimize the risk of stroke, along with advanced diagnostic cardiac imaging to ensure patients receive the best possible care for their condition.
“I’m very proud of our team for this exceptional accomplishment,” said Dr. Jonathan Sherman, an interventional cardiologist with Aurora Denver Cardiology Associates and Medical Director of TMCA’s TAVR Program. “It’s no easy task to get through the ACC’s certification process,” he said. “Our team is dedicated to providing world class cardiovascular care and we have integrated quality initiatives, evidence-based and clinical best-practices, and the latest medical guidelines into our care processes.”
“Our team is very focused on outcomes and continually improving the care we provide,” said Ryan Simpson, Chief Executive Officer of The Medical Center of Aurora and Spalding Rehabilitation Hospital. “This is another step in our ongoing effort to optimize the care and outcomes of patients as we strive to be the Rocky Mountain region’s leader in cardiovascular services.”
The ACC offers U.S. and international hospitals like The Medical Center of Aurora access to a comprehensive suite of cardiac accreditation services designed to optimize patient outcomes and improve hospital financial performance. These services are focused on all aspects of cardiac care, including transcatheter valve therapies.
To learn more about TMCA’s heart programs, visit www.AuroraMed.com/heart.
SUBMITTED BY FAMILY FEATURES
Making time to enjoy the outdoors is a simple way to boost your physical and mental well-being, no matter your age. Whether you venture out to the porch to watch the sunset or lace up your golf shoes for an afternoon on the course, there are plenty of ways you can take in some fresh air.
Going outside generally results in more physical activity than if you were to stay cooped up inside, and it’s an easy way to socialize and interact with others. It also plays an important part in maintaining your vibrancy.
Get inspired to spend some quality time outside with these ideas:
Take up a hobby
Planting a garden or tending a flower bed is terrific motivation to spend more time outdoors, and you’ll have the bounty of your work to enjoy, as well. Even a box garden designed for a smaller space requires regular care, so you’ll find yourself outdoors on a consistent basis nurturing plants to grow.
Take in a performance
Outdoor theaters offer numerous forms of entertainment from music concerts to plays. Before shopping for tickets, be sure to consider any discounts you might be able to use. For example, AARP members can find discounts on tickets for a wide range of events.
Increase your exercise
Even if you have some physical limits, keeping your muscles stretched helps maintain mobility. That might mean taking a walk or playing a round of golf. You could gather family or neighbors for a game of croquet or just move outdoors to do your daily stretches. Find a way to blend your daily exercise with the chance to get some fresh air for maximum benefits.
Go on a trip
The sights and sounds that go along with exploring somewhere new make it easy to enjoy spending time outside. Be sure to make plans for entertainment while you’re on the road, and rather than driving home in the dark or when you’re tired, consider making a hotel reservation through the AARP Travel Center. You might even consider organizing a weekend getaway with a partner or friend who shares your interest in discovering a new destination.
Enjoy a meal out
Dining al fresco is a treat when the weather cooperates, but you can incorporate a delicious meal as a bonus when you’re out and about even when the weather is less than ideal. You could opt to spend your wait time outdoors, or reward yourself after a walk with a special seafood, Italian or steak dinner. You might even pair the meal with a concert or a show for a truly enjoyable evening away from home.
Get creative when you think about how you’ll make more time to spend outdoors and remember that resources exist to assist with planning and saving money along the way. Learn more at aarp.org/memberbenefits.
In his best-selling book entitled, Bowling Alone, Robert Putnam outlines that social capital and civic engagement have declined in areas such as organizational membership, attending religious services, attending club meetings, marriage, bowling leagues and interacting with others face-to-face. He finds that connections in the workplace and with family and friends have also declined. Volunteering, reciprocity, and trust in others are on a downward trajectory.
Though experts debate the term’s precise meaning, “social capital” generally refers to the health of interpersonal relationships and positive social connections. Health professionals are concerned that Americans are increasingly isolated and unhappy, which is manifested in the weakening of the “bridging” and “bonding” forces that build social structures affecting mental health and overall well-being. Putnam goes even further and opines that social capital is a key component to building and maintaining a functional democracy.
The causes for this decline are numerous and complex. Experts highlight that financial anxiety and the changing workplace, along with mobility away from nuclear families and suburbanization, account for a portion of the change. Putnam has unmasked that the internet is a possible cause due to the tremendous time-suck of multiple ways to feast on social media, the internet and entertainment options that are endless.
With the constant chatter of economic, health and social disparities, social capital is considered a major causal factor. The downward social capital spiral is more evident and pronounced in lower socio-
economic communities who have seen a decline in marriage rates, a spike in non-marital childbearing, substance abuse, homelessness, mental distress, isolation and rising male unemployment. Certain areas of the country, particularly rural areas, have been hit hard by an epidemic of drug addiction and economic downturns.
The decline in social capital has several consequences for society. When social capital is high, children do better in school, neighborhoods are safer, people prosper, the government is better due to a higher civic-engagement rate and accountability from constituents. People are generally happier and healthier. A deficit in social capital leads to more suicide, depression, crime, and other social problems.
Social policy should be aimed at strengthening the family, creating more neighborhood recreation centers, making schools a hub of social and recreational activity as well as academic opportunity for all ages. Developers should attempt to create sidewalks, community pools and activity centers to galvanize the new neighborhood with opportunities for neighbors to get to know one another. Those who are currently in neighborhoods that feel like residents are isolated should take the lead and host community progressive dinners, barbeques, events, block parties, fun-runs and holiday open houses increasing networking opportunities. Workplace leaders should find ways for their employees to get to know one another independent of their job duties. Faith leaders should make every effort to reach out to their community and find ways to serve and connect outside the walls of their facility. They should increase the number of small groups they have creating spaces for folks to have dinner with one another or have an event that intrigues and captivates even the most resistant isolated members. Let’s face it, no one likes bowling alone. email@example.com; www.myrelationshipcenter.org
Because of my mobility problems, I’m thinking about getting a walk-in bathtub that’s easy to get into and out of but could use some help selecting one. What can you tell me about walk-in tubs, and can you recommend some good companies that make and install them?
Bubble Bath Betty
Walk-in tubs are a good option for mobility challenged seniors because they’re much easier to get into and out of than a standard tub, and will help prevent slips, trips and falls too. Here’s what you should know.
Walk-in bathtubs are uniquely designed tubs that have a watertight, hinged door built into the side of the tub that provides a much lower threshold to step over (usually 2.5 to 7 inches) versus a standard tub that’s around 15 inches.
In addition to the low threshold, most walk-in tubs also have a built-in seat, grab bars, anti-slip floors, anti-scald valves and a handheld showerhead. And many higher-end models offer therapeutic spa-like features that are great for seniors with arthritis and other ailments.
The kind of tub you choose will depend on your needs, preferences and budget, and the size and layout of your bathroom. The cost of a walk-in tub today with professional installation ranges anywhere from $3,000 to $10,000. Here are some other things you’ll need to consider, to help you make a good choice.
Tub size: Walk-in bathtubs vary in size. Most models have high walls between three and four feet high, and are between 28 and 32 inches wide, but will fit into the same 60-inch long space as your standard tub without having to reconfigure the room. There are also bariatric walk-in tubs that have wider door openings and larger seats to accommodate people over 300 pounds.
Wheelchair-accessible: Most walk-in tubs have an inward opening door, but if you use a wheelchair, an outward opening door may be a better option because they’re easier to access.
Tub options: The most basic and least expensive type of walk-in tub you can get is a simple soaker tub. But depending on your preferences, you have many other options like an aero therapy (air jets) tub, hydrotherapy (whirlpool water jets) tub, aromatherapy tub that mixes fragrant essential oils with the water, or a combination tub that has multiple features. Also, look for tubs that have an in-line heating system to keep your bathwater warm while you soak.
Fast fill and drain: One drawback to using a walk-in bathtub is that the bather must sit in the tub as it fills and drains, which can make for a chilly experience. To help with this, consider a tub that has fast-filling faucets and pump-assisted drainage systems, which significantly speed up the process. But these options may require some plumbing modifications to your bathroom.
Easy cleaning: Keeping the tub clean should be a priority, especially if you get a therapy tub because of the bacteria that can grow in it. So, look for tubs with self-cleaning systems.
Warranty: The best walk-in bathtubs on the market today are made in the USA. Also make sure the company you choose has a lifetime “leak-proof” door seal warranty and lengthy warranties on both the tub and the operating system.
Where to shop: While there are many companies that make, sell and install
walk-in bathtubs, some of the best in the industry are American Standard (AmericanStandard-us.com), Safe Step (SafeStepTub.com) and Kohler (KohlerWalkinBath.com). Most companies offer financing with monthly payment plans.
Unfortunately, original Medicare does not cover walk-in bathtubs nor do Medicare supplemental (Medigap) policies, but some Medicare Advantage plans may help pay. There are also many states that offer Medicaid waivers that will help pay for the purchase and installation of a walk-in tub to those that qualify, and the VA offers some programs that provide financial aid too.
To get started, contact a few companies who will send a local dealer to your home to assess your bathroom and give you product options and estimates for free.
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