Anyone experience health insurance do a "housecall" in memory care unit?

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Anyone experience health insurance do a "housecall" in memory care unit?

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Yesterday, I received a call from mom's new (changed by retirement benefit admins) health insurance co, requesting their Nurse Practitioner to visit her to get a better picture of her health care needs. I told them that I would be glad to meet with them along with mthr at her memory care home. The phone person was very insistent that she talk to the memory care home to obtain access. I told her that I would talk to the home first.

The last time a NP came out to the home to visit, it was to evaluate her for dementia for a palliative care program. I was not told that NP was coming, and as mthr's health care POA, I want to be there for any medical visit. This NP though that mthr was the most charming, smartest person, and could not understand why she was in Memory Care! Maybe the fact that she is not functional and thinks she's in the college dorm??

Anyway, does anyone have experience with United's House Call or with medical personnel visiting w/o POA in a home?

Paying for Care

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Health insurers/Health plans assign nurse practitioners or case workers to monitor the efficacy of care being rendered to "at risk" patients. This is usually done for certain conditions, and is done with the goal of making sure the patient is getting the best care for their condition. The goal is really financial, but the best way for an insurer to save money is to make sure the patient is properly cared for. Your mother is fortunate to have you. Think of the mothers and fathers who have no one to watch out for them. Even when there is family, the health plans may have special programs available that neither the patient or the family was aware of. My father was on pain meds, and the plan sent a NP to his house. I figured they were checking up because of the drugs. The NP pointed out he was not getting enough exercise and arranged for physical therapy to be done at home. They also suggested some fall prevention counseling. This could also be done in a nursing or custodial care situation.

Most health insurers contract out to a vendor for these nurses (etc) to visit their patients. They get paid by the visit, hence the enthusiasm to come, even if told it is not necessary. The best plans, (like Kaiser and some ACO's) compensate staff based on outcomes, like participation in programs like therapies, medication compliance, and even improved test results or decreased infections. These staff or contractors cannot get results (and credit) if they cannot see the patient. They also see their share of family members and facility staff taking advantage of - or even abusing patients. This can be a valuable service, and it's included in the insurance.

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My mother-in-law has had Kaiser insurance for decades, and now that she's in a memory care unit she no longer has to go TO the doctor, they have one come to her. I still have to take her to the clinic for a few different things, but it's been really nice having a visiting doctor come and check on all the Kaiser patients at this place. For us it's been a good thing, but sounds like what you're all talking about is something else. I say anytime I don't have to make the trek to a doctors office with someone who is physically and mentally having issues, good deal.

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Surprise, if it were me I'd be incandescent. The point the NPs and the MCU is missing is that as your mother's healthcare POA you are legally responsible for this aspect of her wellbeing - you're not just meddling for the jolly fun of it. They should no more contemplate interviewing your mother without you there than they would contemplate attempting it without HER there. You speak for and on behalf of her.

"For the avoidance of doubt" you want to say to all concerned "no interviews except by appointment, and with either myself or a member of the NH staff approved by me present. Crystal?"

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BCBS has been sending out doctors or nurses for a couple of years now to do a screening of what is wrong with patients and how they are being served. The visits as optional. I get the feeling it is checking behind the doctors to see if they are doing the right things. In reality I have found the visits to not be useful. We've had people visit three times now.

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yes my husband had them come twice last yr. which I didn't like because is was like she was just insisting to let us come to visit. finally we decided to let her come. she want to make sure he is picking up his prescription and is taking them accordingly . now my husband is 61 yrs old. and he is hard headed. but she doesn't come to diagnose him she can tell him what kind of doctor he needs. this was with united health. but anyways, he really doesn't care to have them come anymore cause he thinks they are telling him what to do. they are suppose to call in advance. not allow to pop up.

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Yeah Senior Blue called me and I told them she is not home any more, she is in an ALF and they have nurses on site, so it was not necessary for them to go.

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(I'm the OP).This service is offered to all of United's Medicare Plus patients, and Appointment Maker was certainly trying to run over me. I pointed out that mthr has an appt with doc right before mother's day, and that there was no reason for a NP to evaluate her this month. "The doc visit would not matter, this was for their own purposes." That statement is what made me highly suspicious.

I will tell them when they call tomorrow that we decline. I already told the caller that I was the POA and that I had submitted the documentation to them before 1/1 when coverage began so they would be able to talk to me. I am not convinced she believed me, still, but I know mthr is "not able" to have online access to her insurance account, and I believe the POA is why - someone out there did believe me.\

Thank you all so much for telling me about your experiences. With the daily calls, and finally actually being able to answer the phone before it went to VM, I have felt a lot of pressure and stress. Now I can be assertive.

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the insurance industry is a vile joke and a sham. they hire highly skilled medical personnel who should be in the healthcare industry as providers. its a sad waste of human resources. with my 20 year foresight i can see their demise but its happening too slowly to suit me.

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If mom is at a Memory Care Home, I'm assuming this a LTC facility with full staff and that includes a medical director and a DON - director of nursing. As such they & the residents family who is DPOA & MPOA will have "care plan" meetings (my mom's is every 3 months) in which mom's needs (medical, social, dietary, etc) are reviewed. They are the gatekeepers for what goes on, not the NP who just came onto the scene. My experience is that the DON is pretty well the goddess & ruler @ the facility and is likely not to take kindly to anyone from the outside coming in without her knowledge to "evaluate" and pass judgment. The DON may be a masters degree RN too while the NP may not be an RN but rather a LPN - there is a real hierarchy in the health care industry on who trumps who too. So that being said I would have a word in private with the DON on all this before the visit. I would clearly tell her what happened with the last NP visit too.

You as the DPOA can request for certain people not even to be allowed to visit @ the facility or can visit only with your being there. But before you go with this nuclear option, I would say to the NP that since mom is at memory care then mom is not competent or cognitive to communicate responsibly so therefore either you or the DON will be there during the visit. You can fax this request to United Health too.

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Nurse Practitioners are not LPNs. They have Master's degrees. Some places they are called aprns.

Anyone experience health insurance do a "housecall" in memory care unit?

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