Choosing Good Care Within the Medicare System

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When I think of an insurance scams I think of companies who profess to assist in “sex addiction” (whose not addicted to sex?), eating disorders (really — Karen Carpenter still died and Oprah is still overweight) or exhaustion (who isn’t?) But, now that I work with families in assisting their elderly parents/grandparents I find the true insurance scam is against seniors.

First, medicare supplement insurance companies — and, some are the largest insurance companies in the United States. I have a client couple, the Smiths. Mr. & Mrs. Smith have two very different needs as seniors. Mrs. Smith has dementia and lives in a nursing home. Mr. Smith, the elder of the two, lives in an assisted living center. When I met them they had the same doctor and the same medicare supplement plan. The physician who cared for them through their plan would speak loudly to Mrs. Smith and give her more medication to subdue her. If Mr. Smith had an ailment that she couldn’t’t check off in the supplement insurance form he was sent to the emergency room for diagnosis. In one three day period, Mr. Smith went to the emergency room twice (Not the “nice” advertised ER —the one for medicaid and medicare recipients). After they second stay they kept him overnight (it’s the only way medicare will pay for the second ER visit) and diagnosed him with . . . ready for it . . . dehydration. Because insurance companies need to make money from medicare they find the least competent doctors, who in turn check as many boxes as possible to refer out to other medical practitioners so everyone makes more money.

My first recommendation was to have two separate policies and pay the $25.00 a month for a PPO. The health care improved but the insurance company did not. As part of our services we monitor the monthly billing. To date, we have had to call the insurance company more often than not for over-billing or wrongful billing.

Bottom line, you cannot expect an elderly person to actually understand insurance bills. Besides a “bill” in which money is owed there are also the more confusing documents titled, “This Is Not A Bill.” The insurance companies actually make millions from wrongful billing because who has the time to decipher the bill? Or to call and hold a minimum of 45 minutes with “customer service”(an oxymoron). Then when the representative speaks he/she does not know the answer which means you hold and hold and hold to speak to the supervisor who’s not available so can you hold . . .

My way of thinking is that maybe it’s easier to call yourself a sex addict, a food addict or exhausted — at least those companies know which box to check and someone makes money! Our seniors, who have added value to our country and society, certainly aren’t getting their fair share. And, if you think these insurance companies are bad . . . wait until we discuss the Long Term Care Insurance Scam!