Benefit Bulletin: Complexity Means You May Be Missing Out On Benefits

Benefit Bulletin: Complexity Means You May Be Missing Out On Benefits

Complexity Means You May Be Missing Out On Benefits

The enormous complexity of our healthcare system is making people sicker and costing consumers more out-of-pocket than it otherwise should. When private health plans don’t pay as expected, patients can wind up with surprise bills that left uncontested, can put a huge burden on household budgets.

William P. of California, who is bedridden due to degenerative hip disease, is a case in point.  William was forced to spend thousands of dollars of his savings paying for his home healthcare costs when his health plan failed to cover his care after he fell and became bed-ridden in 2017.  Because William requires transportation by ambulance to doctor visits, his HMO alleged that he did not meet the “ambulatory care requirements” of his managed care health plan and his health plan denied his claims.

TSCL was able to help William contact a constituent services staffer at the office of his local Member of Congress.  That contact, and William’s subsequent correspondence with his HMO, started the process of unraveling the snarl of red tape.  William finally got the medical attention and refills for the prescription drugs that he needed and went without for several months of last year.  During last fall’s Open Enrollment period, William switched from his former HMO and enrolled in traditional Medicare with a supplement for 2018.

The nation’s healthcare system can be too complicated, and the financial risk of making the wrong choice is very high.  Patients should not face bankruptcy simply because they don’t know, or are too sick to jump through the correct set of hoops to get care.  If you have questions about your coverage, one of the best sources of information is your State Health Insurance Assistance Program (SHIP), which provides free, unbiased one-on-one screening, counseling and assistance in signing up for Medicare and Medicaid programs that can help lower your healthcare costs.  Many of these programs operate through your Agency on Aging.  Yet, despite the growing need, government funding for SHIP, and other programs that serve older Americans, remains flat.  That means local programs are making do with less.

If you need help with your healthcare coverage, we encourage you to contact your local Agency on Aging or senior center.  TSCL strongly supports funding for the Older Americans Act that helps fund SHIP.  We encourage you to contact your Members of Congress, and talk to prospective political candidates, about the importance of federal funding to serve older Americans.

Source:  National Council On Aging, December 18, 2017.