Who are the Grands?

They are 90 and 93, and they live each day like there is no tomorrow. Because there may not be. Their minds are not what they used to be and their bodies are breaking down bit by bit, but inside those old minds and bodies they are the same independent-minded young people that forged their own way in this world and made a good life for themselves. This is both a blessing and a challenge, as you'll see in the posts below. Welcome to our journey!

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Sunday, March 9, 2014

Victory!! The Grands Battle the Insurance Company and Win!

In 1990 the Grands purchased long-term care policies from a friend of theirs who worked for Union Bankers Insurance. The policies were for nursing home coverage because back then nursing homes were the only facilities that provided actual nursing care. Well, the evolution of nursing care has been vast and extensive, and today there are far more options available to seniors than institutionalized care at the glorified hospitals called nursing homes. Most companies, Union Bankers included, have broad enough definitions to cover assisted living facilities, too.

When the Grands moved into Bickford House last June, this was one of the first things I wanted to know from Union Bankers. The young woman I spoke with assured me that Union Bankers covered assisted living, too. Great! I scheduled a nurse to come out and assess the Grands for their insurance claim. Everything went swimmingly, and the nurse recommended that they needed care to the company. Great! I was told by a manager at Union Bankers that the Grands were approved for care. Great again!

Not so great. A week later I received another call from the same manager telling me that the facility did not qualify because it was not under the supervision of a doctor. Never mind that Bickford has a collaborative agreement with a nurse practitioner and that there is round-the-clock supervision by the RNs. Never mind that Union Bankers very loosely defines "doctor" in the contract as a "licensed healthcare practitioner" which could mean a nurse, nurse practitioner, or physician. Union Bankers had just decided on its own that Bickford didn't qualify.

I was shocked but I was also absolutely certain that this was not the end of the discussion. By this time, the Grands had been at Bickford for two months and were comfortable and getting settled. The manager callously informed me that I could move them to another facility. She suggested that I move them to a 'real' nursing home. So, I said, let me understand, you want them to give up their quality of life at Bickford and enter an institutionalized setting because of Union Banker's unjust assessment? I asked her if she had any idea what it was like to move elderly people, how difficult and psychologically traumatizing it was. She responded only by telling me that I would have to talk to the claims department.

This woman showed no humanity, no compassion, and no care. To her, these were just names on a piece of paper. How wrong, how wrong she was. The Grands are real people with real lives, real feelings, and real love in their hearts. These are my grandparents who raised me, gave me the only stability I ever knew, and loved me since the day I was born. My heart told me, how dare she treat them like names on a page? At the same time, my head told me that this was the way of the world.

That day I resolved that I would fight this company until the very end, until there was no fight left. That day began an eight month battle as I sent letters, made phone calls, sent more letters, resent letters that they "lost," followed up on phone calls, followed up again because they told they hadn't processed the appeal yet, followed up again and again and again. I quoted the policy to the company to show them that Bickford qualified. I involved the director of Bickford who made multiple phone calls and sent letters, too.

Finally, I was told no again and I filed a complaint with the Department of Insurance. Union Bankers persisted. They even gave the Department of Insurance the run-around. But that didn't last too long, because finally the Grands and I, the little fish in the big pond, had some muscle. If you are an insurance company, it's best not to mess with the Department of Insurance.

Still, more weeks passed. I felt like that little red fish, holding on for dear life and not knowing quite what the point was. I was feeling pretty despondent. Every day, Grandma asked about the insurance. Did you call them today?, she'd ask. Every single day.  I couldn't blame her - we were talking about a lot of money. Lots and lots of money that would really help them pay for their place. I knew how much it meant to all of us. I tried to be patient. I think I succeeded for the most part.

But I was tired, weary of the whole thing. This wasn't the only thing on my plate. I remained confident that we would win in the end, but I knew that it might last a lot longer. I knew that I might need to hire a lawyer and sue the company. I didn't want to do that, but I would if I had to. I had already talked to a lawyer here in town. I just wanted it to be over. I prayed, as I had prayed throughout this time. But this time I just it gave it up to God. I handed it all to Him. I knew that I was at the end of myself because I was just too weary. That was Wednesday.

Then, out of the blue, as these things always happen, I got the call. It was Friday afternoon. I answered the phone. At first, I had no idea who it was or what she wanted, but after a minute or so it became clear that this was a manager from the Grands' long-term care insurance company. It was the very same manager that had callously told me to put them in a nursing home. She was calling to inform me that the company had approved the Grands' claims. She repeated it several times in a tone of voice that said she couldn't believe it herself. She told me Union Bankers would start cutting the checks immediately. Immediately!!

Relief and joy and gratitude washed over me. Relief that I no longer bore the burden of this battle, joy that the Grands had experienced justice, and gratitude to God for all He has and is and will do for us. Woo hoo!!!

I went over to the Grands that night. I had them sit beside each other so I could tell them the amazing news! Grandma's jaw hit the ground and then she smiled. Then she laughed. She laughed and giggled in joy. Grandpa nodded his head and said, "Thank you, Lara. Thank you." Grandma sang "Thank you, God" and "Count your Blessings." The fight was over. And we won! We won!

Victory!!!! We did it! Grandma was once a Rosie the Riveter, so this seems appropriate: