Refusing Medical Care Because of Money Worries

POTENTIAL SITUATION

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Donna’s father, Neal, an 80-year old Korean War veteran, has been extraordinarily healthy throughout most of his retirement. However, lately, he has 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 has begun 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 is refusing, saying he can’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 insists.

PARAGON’S SOLUTION

Donna may feel worried and frustrated with her father and express that during a normal progress meeting with PARAGON advisors - and we would become immediately on alert. The behavior that Neal is displaying seems unusual, but not particularly rare. Specially trained to deal with senior issues, and with specific designations to help us to understand problem areas, we might suspect that Neal simply does not understand his health insurance. We would then ask Donna to bring Neal by the office for a chat.

Let’s say that Neal has employer-provided retiree insurance, and the premiums are automatically taken out of his monthly pension payments.  Over time, like many seniors, Neal could have forgotten the details of how his health insurance worked.A phone call to Neal’s insurance company, with Neal on the line, would provide the answers. Neal’s policy may be a “Medicare PPO” plan – a plan which operates within the constraints of Medicare but does not “look or feel” like typical Medicare.  With this type of plan, Neal would not have a Medicare card like his friends, and, because of the situation, would think he did not have Medicare coverage and subsequently would have to pay for the surgery out of pocket. As it turns out, this insurance plan is very good, and the hypothetical 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 understands his health insurance coverage, Neal may decide to have the recommended surgeries. After several months of physical therapy, he can be up and walking around enjoying his new, pain-free mobility. Hopefully, the pain in his hips and back would go away.  With the surgery (and barring any other medical problems), Neal will still be able to live independently, in his own home for years to come.

*Please Note: Limitations: The above Case Study is hypothetical-not involving actual Paragon clients. Case Studies illustrate the hypothetical experience of a fictitious client based on a scenario that an actual client might experience. The Case Studies are designed to generally illustrate how we may provide our services to our clients. Keeping in mind that no two clients, situations, or experiences are exactly alike, the Case Studies are not to be construed as an endorsement of Paragon by any of its past or current clients, nor any assurance that Paragon may be able to help any client achieve the same satisfactory results. To the contrary, none of the Case Studies should be construed by a client or prospective client as a guarantee that he/she will experience a certain level of results or satisfaction if Paragon is engaged, or continues to be engaged, to provide investment advisory services.

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