Friday, July 10, 2015

Always Ask Before Being Admitted to a Hospital ~ Am I An Outpatient? Or Am I An Inpatient?

When being admitted to hospital, no matter the reason, you will be confronted with a bewildering array of paperwork. You may be unaware that 'admitted' includes two categories -- 'inpatient' and 'outpatient.' If you have Medicare Part A, Part B and Part D insurance policies YOU SHOULD ASK - "Am I an inpatient or outpatient?"

You do not have a choice, because Medicare sets the criteria. However, you should know because being an outpatient could be costly to you. Medicare rules define medications for which you have a prescription from your doctor as "Prescriptions (Self-Administered Drugs)." As an outpatient you are responsible for payment when a "self-administered" drug is given to you from the hospital pharmacy.
"Their cost can be extremely prohibitive, and in many cases Medicare members discover an outpatient is responsible for the hospital fees for those prescription drugs too late," Rod Haynes, Centers for Medicare Medicaid Services (CMS)/ Consortium for Medicare Health Plans Operations (CMHPO) Region 10, said.
This government publication explains how it works. 

You need to be very clear about which prescription drugs your Medicare-D insurer covers, and the conditions under which they pay, or in some instances, DO NOT PAY. This is vital knowledge before allowing the hospital to remove any self-administered drugs you've brought with you. Medicare rules stipulate,
"If you bring your prescription(s) from home, we [the hospital] are required to obtain approval from your physician prior to use. In addition, a hospital pharmacist must verify and certify the medication before it can be used in the hospital. There is a small fee for the medication verification."

There is no standing Medicare rule mandating that hospitals must allow patients to bring in their prescriptions when receiving care. Individual hospitals may or may not choose to permit this practice.
Why will prescription drugs you've brought (whether you're a patient in the ER or in a hospital bed) be sent home, leaving you to take medications from the hospital pharmacy instead? In most hospitals today there is no procedure whereby you can be charged a small fee and allowed to save substantial sums; the difference between what you will be charged for the hospital pharmacy's medications and your brought-from-home prescriptions. Even though they are identical.

Sean E. Dobbin, PharmD, Director of Pharmacy, Providence Sacred Heart Medical Center & Children's Hospital, explained that hospitals use digital-coding systems, much like the bar codes on items sold in stores. Hospital digital-codes coordinate your every medical procedure, including the medications you're given.

When a nurse scans the band attached to your wrist, it must match the digital-code on the medication being given. Although hospital administrators are concerned about the resulting high cost to patients, hospitals have not yet designed an efficient method to enter prescription drugs brought to the hospital by patients into their digital-coding system.
Complexities preventing this include: How can a hospital pharmacist ascertain the patient brought prescriptions that,
  • Have been stored properly?
  • Aren't from an expired batch?
  • Are the strength the doctor prescribed?
  • Or that dosage changes haven't been made since the prescription was written?
Hospital pharmacy fees for one dose can equal or exceed the price of a thirty-day supply of the identical medication sold at your pharmacy -- a substantial difference for which your Medicare-D insurer may not reimburse you.

Many diseases require medications that are catastrophically costly, yet vital to the patient. To miss even one dose may be highly risky or even deadly, but it's up to each hospital whether or not to accept the risk/liability of a patient bringing their prescriptions from home. Before relinquishing your medications, insist on meeting with the hospital pharmacist prior to taking any medication. This way, rules can be agreed on in advance regarding your self-administered drugs, or any drugs you know your Medicare-D has restrictions for.
The Medicare Rules also stipulate, "As a courtesy, we will bill your supplemental insurance on an "assignment" basis. This means we will ask the insurance company to pay us directly. Any amount not covered by your insurance will be your responsibility."
This does not apply to medications in the self-administered category. According to a finanial counselor at Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA, it means the hospital may bill for covered medications under Medicare Part A Supplement Plan. Hospitals do not bill insurance companies for self-administered prescription drugs received from the hospital pharmacy that are covered by Medicare-D insurance. The patient is billed and bears the responsibility to file a claim for reimbursement from their insurer.
Haynes said Part D is a separate matter entirely. "While hospital pharmacies are technically permitted to contract with Part D plan, it is very rare for them to do so because of financial constraints. If a hospital is willing to submit a patient's Outpatient drug claims to his or her Part D plan for reimbursement prior to billing the patient directly, such an arrangement would be entirely up to the hospital pharmacy. There is no Medicare rule mandating that the hospital do this," he said. The patient is left to suffer the consequences – or seek relief.

If for any reason you haven't reached an agreement with the hospital pharmacy beforehand, as soon as you receive their bill for the self-administered drugs you were given as an Outpatient, promptly talk to the hospital's Financial Counselor and to the Director of Pharmacy. Explain circumstances you feel should be considered, and request an adjustment. There are 'conditions' the hospital can apply to mitigate the charges.

If you need to file a claim for reimbursement from your Medicare D insurer, obtained the Prescription Drug Claim Form from the hospital's Outpatient Pharmacy Billing Department. The hospital pharmacist needs to fill out a form for each self-administered drug the hospital has billed for. Send your claim for reimbursement from your Medicare-D insurer before that insurer's deadline; keep copies.

If your claim is denied, attach copies from  your original claim and file an appeal. If a medication is not covered under your Medicare-D policy present the facts to the hospital's Director of Pharmacy and requested a review by that department. The charges may be mitigated and dismissed because of 'conditions' that meet certain criteria at that hospital.

If your insurance doesn't cover the costs, and you fail to get remediation from the hospital pharmacy, meet with the hospital's Financial Counselor. You may qualify for financial assistance, or at least be able to arrange an acceptable payment plan.

Sources:, the Official U.S. Government site for Medicare.
Search self administered drugs to get a the (pdf) Publication, "Self Administered Drugs" It explains how Medicare covers self-administered drugs given in hospital outpatient settings.
Here you can find 118 Publications that answer Medicare questions.

Thursday, July 2, 2015

"Worley Spotlight," by Sue Ellis Published in July "Idaho Magazine"

Fans of former Palouse resident, author Sue Ellis, can enjoy another of her charming stories, Worley–Spotlight, published by Idaho Magazine.

Congratulations, Sue!

Fellow Internet Writing Workshop  [IWW], member, Paul Fein, had this to say,
"Sue, I thoroughly enjoyed your engaging, authoritative piece."

His favorite sentence for pure writing in Worley Spotlight is:
"By then they were stoop-shouldered from years of leaning into a task, and their faces were creased like roadmaps to kindness."
Paul also said,
"Readers will really appreciate the history you've given them."
 He cited the following paragraphs in particular:
"The many businesses that lined Worley’s main street are dramatically fewer than they used to be, unable to complete with the nearby casino or the lure of better bargains within a forty-minute drive to either Coeur d’Alene or Spokane."
"The Grange is a fraternal organization whose roots go back to 1867. The brainchild of Oliver Kelley, it was created at the urging of President Andrew Johnson as a means of bringing people of the southern and northern states back together after the Civil War. It succeeded. A lot of good was accomplished by the cooperation of dues-paying members over the years."
Tennis fans applaud Paul Fein's websites, Paul Fein's Tennis Confidential and Greatest Tennis Quotes, Insights and Zingers .

Monday, May 25, 2015

How to Find Your Ancestors in Limited Edition Regional History Books

Until Karen Drain read a newspaper account about her Honberger ancestors in Behind These Mountains , she said,
“I knew only that they were present for part of Heron’s history, for good or for bad! I found your books through genealogy research. My ancestor is listed in a newspaper clipping you included in a book.
When I found the listed page, I thought that the books would provide great reading material for my [91-year-old] Great Uncle Jack, who is helping me build the family tree. [And] my thoughts of buying your books in hardcopy were my only hope of sharing them with him."
She’d read the 1919 Sanders County Independent Ledger account of a “saloon keeper” whose business had been robbed. She contacted me. I connected her with people still living in the Heron area who might be helpful. Through them, she touched bases with others who also added to her knowledge about her family connection to former Heronites.
Karen said,
“Heidi [Dettwiler], Phoebe Harker, Linda Rocheleau, Fredi Pargeter, and Helen Meadows have all reached out to me and I am so humbled by everyone’s generosity in assisting me in my family search. You all are so wonderful!”
However, the Behind These Mountains trilogy she wanted to purchase has become rare out-of-print collectible books. Like most regional history books, they were limited editions; 1,000 volume 1 copies and only 500 copies of volumes 2 and 3.
Until I told her about requesting books through Inter-library loan, Karen wasn’t aware of that library service.  A librarian searches for them and when located, requests a copy that library clients can check out to read.
In 2009, Kindle editions of Behind These Mountains, Volumes I, II & III became available. Since there are about 1,000 vintage photographs from homesteader’s private albums in them I also offer .pdf formatted editions of the trilogy on a DVD for $50. The .pdf editions are a popular choice for those wanting print books because I include permission for a buyer to print [or have printed] a personal copy of each approximately 1200 page book. Karen elected to buy the DVD.
“I received my DVD today,” she wrote, “and I cannot wait to begin reading [on her computer’s large screen]! My hope is to print out a chapter at a time and send it to my great Uncle Jack. .. My thought is that he will have something to look forward to every week as I send him one or two chapters at a time.

I believe I mentioned that Jack is 91 and he doesn’t even have a working television, let alone a computer. His phone is not a fancy one either so hardcopy is the only way for him to read your book. I want to [print and] send a few chapters at a time so he has something to look forward to and he will check his mail more often than he does! Thank you so much for sharing all of your research!”
Her uncle plans to save the printed chapters and someday return them to Karen.
As she began reading the .pdf copies on her computer, Karen discovered Heron was beset in 1909 by smallpox brought in by a child who had returned from visiting relatives back east. Coincidentally, her relative, Flora Emma Honberger Dingley, died in Heron in January 1909. Now she wonders if smallpox caused Mrs. Dingley’s demise.
In a post on my Bygone Montanans blogspot, which is designed to help people with their genealogy research, I shared family information and photos of the Honberger and Dingley ancestors in Heron, that Karen had sent.
She responded, 
“Thank you for sharing my family history in your blog. Perhaps another family member will read it and add to the information. We are shaking the bushes, so to speak… We are very thankful to find you and your work.”
Laura Becquart, David Miller, Cindy Raynor, Tracey Lewis and Teresa Morkert are also among those who found the regional Montana history online.
When he got in touch, David said, 
Laura also emailed, 
“My name is Laura Becquart and I am interested in purchasing the pdf printable version of Behind These Mountains. I already have the book for volume 1 [original out-of-print edition], and it contains quite a few pictures. Do you know if the pdf version will contain pictures as well? Also, is the $50 for all three volumes?"
When I replied, she responded,
“Oh, this is too cool - I think I'm actually talking to Mona herself! You even signed my original edition of volume 1. My great uncle Lank (Loren Jameson) was able to get a signed copy for both my Mom and I. My Mom is Lucille Jenkins, the grand-daughter of Lucy Jenkins from Noxon.
My brother was trying to find volume 2 and 3 for my Mom for Mother's Day. I told him I would look around on the Internet and see if I could find anything for him. Of course, there wasn't anything out there, but I did stumble upon your Behind These Mountains website. 
Would it be acceptable for me to mail you a check? I'm fine waiting for you to cash the check before you would mail me the pdf file.”
We emailed back and forth as I related personal memories of times my husband and I enjoyed with her ancestors during the 60-years we lived near Noxon. Her check arrived and the DVD went in the mail the next day.

Tracey Lewis found ancestors in my books, connected with living kinfolk she learned about using Internet reseach, and traveled hundreds of miles to meet some of them in person. As the families connected, they used emails, phone calls and letters, to discover other members of the family tree, and organized a grand family reunion for fhose they found.

We learned much about our Gremaux family ancestors from a little-known out-of-print book in a library in Indiana. More information about that branch, and also the Vanek branch of our family tree, is located in a library in Lewistown, Montana. Many northwestern Montana settlers relocated to the lower Clark Fork River valley from the Plentywood area in Montana. The library there hosts detailed accounts of their lives.
How can you find your ancestors?
  • Locate a library or museum in a town where an ancestor lived. Ask if any regional history books have been published. Request any that you find through Inter-library-loan. 
  • Ask if there is a talking book or digital version. Many old books have been republished in a digital book, or online.
  • Type family names into several online search engines. Each may return different results.
  • Utilize You won’t need to subscribe to if your local library has access that you can use free.
  • Research ancestors through The Church of Latter Day Saints’ genealogy resources. is an excellent resource for locating books, periodicals and authors. The website has a powerful search engine, and is intended to provide convenient access to a large quantity of high-quality content material, mostly published over the last 150 years in America and England. It accesses over one million readable items, and titles of another million items not readable due to copyright.

You, too, might find and learn more about your ancestors in a little known regional history book. In doing so, you'll also make a author as happy as I am ~ knowing my work connects families.You may also have a grand reunion, like Tracey Lewis and her kinfolk, of family tree members you have yet to meet.


Wednesday, February 11, 2015

Open Invitation to Mardi Gras Party at Broadway Court Estates, Spokane Valley, Wash.

On March 17th this year this domain will no longer be funded at which time my understanding is that the website will become extinct. However, before the Palouse website just disappears in March and GoDaddy advertises the domain for sale, Joel Kimball, owner of Palouse Internet, a small town Internet Provider in Tekoa, Washington has been interested in incorporating it with his services. If you favor that, you can contact Joel at 509-284-2518.

Eric Eden listed our house at Rockford that we enjoyed while I was publishing The North Palouse Washington eNewscast. We hope you'll find touring the house and property fascinating!! Please share it. We believe another family should be enjoying that lovely place as much as we did during the ten years we lived there. 

We're happy to report that our move to Broadway Court Estates Assisted Living Retirement Community has turned out well. Fabulous Valentine's and Mardi Gras entertainment will enliven this month. And Broadway Court Estates  extends an open invitation for everyone to come February 17th to enjoy the special entertainment for Fat Tuesday from 1-1:30 p.m.

Only five apartments in this privately owned establishments are available for rent now, and tours are available. Come and enjoy the camaraderie and special entertainment planned for the public that day. Mention to the sales representative, Jennifer Jordan that you read about it in The North Palouse Washington eNewscast!

Thursday, October 30, 2014

Adieu North Palouse Washington

Dear Readers,

Until last spring my husband and I had always been active and independent. We entertained, played cards, went fishing, attended fairs and festivals, RV traveled, grew a garden, maintained our home, and enjoyed a variety of hobbies.

We envisioned living in a home of our own the rest of our days.

We never for a minute thought we'd reside in an assisted living community.

And then during Easter weekend I suffered an attack of benign paroxysmal positional vertigo [BPPV]. You may have read my story at that time. Shortly afterwards, I put Palouse enews on hiatus because of numbness in my hands and nerve pain in my arms.

To friends and family, during the weeks following my BPPV, I described how doctors twisted neck in the CPR Epley maneuver that was
performed in a hospital, and the follow up treatments I had at a rehab center. Emails about them flew between us for a couple of months afterwards, often crisscrossing in the Ethernet.

Doctors didn't tell me about CPR's potential complications which include the possibility of neck/back injury, or I would have refused the treatment. Forty years ago my neck was broken when the pickup I was a passenger in was rear ended.

On the Monday after Easter weekend, 2014, the medical specialist who performed the Epley maneuver on me failed to consider my previous medical history, or perhaps the doctor hadn't read my medical chart and didn't know about the 40-year-old graft in my neck.

As a result, my life changed overnight. I went from being primary driver and helpmate to my husband to being dependent on him for everything.

During the next three months I was transported by ambulance five times to hospital emergency rooms, before a doctor ordered an MRI. C-6 and C-7 discs in my neck were damaged by the Epley head maneuvers.

He referred me to a neurosurgeon.

Before the neurosurgeon's "earliest available appointment" on July10th, I accidentally became a drug-addicted great granny for seven days, overdosed and went blind for several minutes--who quit cold turkey, and plunged into withdrawal hell!

Names of doctors omitted to protect them--however, in all honesty what happened to me was partly my own fault, because I'm conditioned to naively trust physicians.

Since I don't even take OTC pain pills I hadn't a clue about today's reality.

A prescription for Hydocodone only meant pain relief. I didn't realize it was a narcotic drug! A very addictive narcotic drug! And it always means you need more, more, more ...

When my doctor's assistant said, "The goal now is pain management until you see the neurosurgeon: Increase the dose,"  to me it meant just that. Take more Hydocodone. It didn't translate in my 81-year-old brain to "doctor's orders don't always include 'no more than X per day'" or "go online and educate yourself about the medication."

Later, my neurosurgeon said Hydocodone doesn't work for nerve pain. She prescribed Gabapenten, and increased the dosage in small increments to achieve temporary relief. I went online to Mayo, and read all about Gabapenten before one pill went into my mouth!

Suffice to say, it was a summer of convincing events and steep learning curves until we accepted the inevitable--our health, stamina, and safety issues showed it was time for a major lifestyle change. So moving into an Assisted Living Community [ALC--not to be confused with assisted living *facility] seemed to be our best option.

Our only previous experience with an assisted living place was visiting friends who moved into
Orchard Crest in Spokane Valley, Wash., a few years ago. We've since learned that many former Palouse region residents also live there.

For those wondering what assisted living means,
A Place For Mom is a premier website to learn about assisted living, where this link provides an explanation of the basic services.

Late this fall we rented an apartment at Broadway Court Estates, an ALC where the meals, maintenance and transportation we desire are included.

We appreciate the conveniences. Personally, my health is improving and I welcome the safety of walking indoors, as well as outdoors on the community's landscaped grounds. Use of my hands without bringing on unbearable pain is improving.

Walking in the warm pool daily, prescribed by my neurosurgeon, may help me avoid neck surgery.  I'm  hopeful that I'll be "fixed"--as my neurosurgeon promised--and someday I'll be able to drive again, and regain some of my former independence.

So there you have it. That's our story of how we came to live in an ALC--and I assure you that although the details vary widely, fellow residents of Broadway Court Estates each have a story of what brought them here.

Two weeks after the shock of moving into an apartment nearly the size of the Montana home where we raised our three children, the happiest things we've learned are that other residents are impressively friendly, meals are good, and the housekeeping and maintenance staffs are excellent.

It's easy to see why those who've lived in this assisted living community anywhere from a month to a dozen years--when asked how they like it--invariably answer, "I love it! Wouldn't live anywhere else."

Although many people live in assisted living communities because of health problems, aging and/or diminished mental status, others choose this lifestyle for a wide variety of reasons, including the simple convenience of not owning/maintaining a home. Most find the social aspects, which often include stellar entertainment, attractive. Many appreciate the convenience of indoor pools and exercise equipment with personal instructors.

I have created 21st Century Old Folks Home, *** ASSISTED LIVING COMMUNITY ~ A LIFESTYLE OF FULLNESS *** ~ The goal of this website is to help and encourage those who never imagined they'd move to an Assisted Living Community, but nevertheless are faced with the challenge.

I hope you visit the blog, and share the URL with others. There's no telling when you, too, might be suddenly faced with the tough decision of moving to an assisted living community.

Come back often. Please leave a comment to guide me as I take up this new challenge, and to encourage others embarking on this phase of life.

It's been a pleasure to share the news on the Palouse, and I'll miss that, and interacting with librarians, town clerks, clubs, organizations, and the friendly residents on the Palouse.

Sadly, the time has come to say "Adieu."

The North Palouse Washington e-Newscast and it's links will stay live until the domain expires, March 27, 2015.

Mona Vanek, Editor

Friday, August 29, 2014

A Best Seller Before Publication!

Charles Hobbs, a member of Internet Writing Workshop, who sent his book through the non-fiction list as he was writing it, is fast becoming a best selling author on Amazon before the November 4, 2014 release of Hidden History of Los Angeles Transportation by Charles P. Hobbs.

As of August 19th, "Hidden History of Los Angeles Transportation" had a sales ranking hovering between 10-12 in the category  "Mass Transit."

Congratulations to Charles, and watch for more here after the first of November, about how and why he wrote this book. 

Sunday, June 22, 2014

"Going Home" by Sue Ellis, is published by MUSED, Bella Online Literary

MUSED - Bella Online Literary, published
Going Home, by Sue Ellis, in their Summer 2014 Volume 8, Issue 2. Ellis' story gives life to a house built on the Palouse in 1909 while weaving into it the vagaries of raising a family in Waverly, Washington. She also portrays the vintage home in it's new life today.

Readers who are familiar with Ellis's charming stories won't want to miss this one in which she outdoes her usual superior evocative and charming style.

Another recent story, a very short piece of fiction, is published in the Short Takes at Persimmon Tree, where you'll need to scroll down to read her story about a tree-faller, enticingly titled
Burned Pancakes. 

Enjoy Sue Ellis' stories that have been highlighted here in past issues:

Life on the Palouse History - A Bucket of Dirt Clods, published in Poor Mojo's Almanac(k) Classics 2000-2011.

Living On The Edge, published at Blue Lyra Review.

Friends a delightful poem about her great-granddaughter Mici and a year-old Labrador pup.

Poetry and Short Stories by Sue Ellis Published , includes links to a few of her delightful stories, published at a variety of venues.