NEW YORK, Aug. 3 /PRNewswire/ -- Empire BlueCross BlueShield – According to the National Alliance for Caregiving,
A caregiver is someone who provides assistance to another person who is ill, disabled or needs help with daily activities. It's a role that can be physically and emotionally draining. The health care system doesn't make it any easier. Fortunately, there are a few tips caregivers can follow to better manage their loved one's health care, particularly when it comes to people with Medicare, according to Krista Bowers, senior vice president of senior products at Empire BlueCross BlueShield.
"At Empire BlueCross BlueShield we hear regularly from caregivers who are learning how to navigate the system on behalf of their parents, grandparents and others," Bowers said. "There are some themes that are common among them."
The first step in helping to manage care for a loved one is gathering as much information as possible about their health and health benefits. Some items caregivers might want to gather include the following:
This is basically creating a "personal health record." A loved one might be reluctant to share this information at first. Experts recommend that caregivers remain patient. They can explain that the information is needed to advocate on their behalf with their doctors, hospitals and insurance companies.
Most people have heard of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA is an important law for protecting patient privacy. However, it can be an obstacle for caregivers.
"People are sometimes surprised to learn that companies like Empire BlueCross BlueShield cannot readily disclose a person's health information, even to their own spouse or child," said Mark Wagar, President and CEO of Empire. "That's why it's so critical for caregivers to file the proper paperwork with their loved one's health benefits provider."
Caregivers can access a loved one's health information in a number of ways. One way is with a "durable power of attorney," which can be established with the assistance of an attorney. Another way is with an "Authorization to Disclose Personal Health Information," which is available from a health benefits company. With the disclosure form, the member can authorize someone else to see their health care information, while specifying just how much information that person can see. Beneficiaries also can designate someone to participate on their behalf in Medicare appeals and grievances by filling out an "Appointment of Representative" form.
These forms are returned to the health benefits company where they are kept on file. When they are on file, designees can serve as the member's representative on health benefits, including determinations, exceptions, and appeals and grievances. Anybody can serve as a designee, including a family member or friend. However, the member can revoke these designations, in writing, whenever they see fit.
Enrolling in a Chronic Disease Program
Some Medicare beneficiaries suffer from chronic diseases, such as cancer, stroke, multiple sclerosis, dementia, diabetes, end stage renal disease or Alzheimer's disease. In fact, according to the Centers for Disease Control and Prevention, eight out of 10 Americans age 65 or older are living with some chronic illness. Those enrolled in a Medicare plan may have access to free programs to help them manage their diseases. Many times, these programs are administered by nurses or other licensed personnel. The goal is to help prevent acute episodes through better disease management. Many plans even follow-up with members after their hospitalization.
"These programs are above and beyond those offered by Original Medicare," Bowers explained. "It's important for caregivers to know about them and encourage their loved ones to participate. They may want to get a copy of a member's explanation of coverage from their insurer to find out what's available."
Knowing Your Rights
Once the disclosure/authorization paperwork has been filed, caregivers can speak to a customer care agent on a beneficiary's behalf as well as access the beneficiary's information online, including claims history, provider network and drug formularies.
If a beneficiary ever disagrees with any Medicare decision, including a denial, they have the right to appeal it. For more information about appeals, visit http://www.medicare.gov to get a free copy of "Your Rights and Protections."
Investigating 'Extra Help'
As a caregiver, it's also important to know about "extra help" that is available to low-income people with a Medicare prescription drug plan through the Social Security office. This "extra help" includes assistance with monthly prescription drug premiums, annual deductibles and prescription copayments. For information about eligibility for this program, go to www.socialsecurity.gov/extrahelp.
Even if your loved one doesn't qualify for extra help from Social Security, there are a myriad of other resources that might be available to them at the state and community levels. The Web site www.benefitscheckuprx.org has compiled information about these resources in one convenient online location. The site tracks more than 1,550 benefit programs throughout all 50 states and the District of Columbia. It has identified more than $7.6 billion in benefits for those in need since being launched in 2001.
Caring for Yourself
The final tip for caregivers, and perhaps the most important, is for them to take care of themselves, including getting enough sleep, going for a walk, taking an occasional day off and maintaining a sense of humor. After all, caregivers can't possibly take care of anyone else until they first take care of themselves.
Research shows that caregivers face an increased risk of developing depression. It's natural to grieve about a loved one's disease. However, if sadness persists to the extent that it prevents decision making, interrupts daily living, and discourages participation in normal activities, then it may be time to get some help. Primary care physicians may offer help, including referrals to other resources. Caregivers with access to Employee Assistance Programs (EAP) can find them useful.
"Caregivers need to know that there's no shame in asking for help," Wagar said.
For more information about care giving and Medicare, including helpful forms, please visit www.medicare.gov/caregivers.
Empire BlueCross BlueShield (Empire) is the trade name of Empire HealthChoice Assurance, Inc., and Empire Blue Cross Blue Shield HMO is the trade name of Empire HealthChoice HMO, Inc., independent licensees of the Blue Cross Blue Shield Association, serving residents and businesses in the 28 eastern and southeastern counties of New York State. Additional information about Empire is available at www.empireblue.com.
SOURCE Empire BlueCross BlueShield
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