Make Health Insurance Choices Understandable
My Mom (84 years old) came to stay with us for an extended vacation back in August. When she arrived she was having difficulty getting around because of bad knees. She had a total knee replacement on the right side and never properly recovered. Part of the reason is that she lived in a row home in Philadelphia. She had to climb 10 steps just to get up to the house, thirteen to go use the bathroom or go to bed and another thirteen to go and wash clothes or get something out of the freezer. Sometimes she had to crawl up and down the steps.
When she arrived here, we made an appointment to see our family doctor. When we called for the appointment we asked if they accepted her health insurance and were told “yes”. When we arrived for the appointment she was told that, with her insurance and Medicare, she didn’t even have to pay the co-pay. A month later they called to say that they didn’t accept her insurance and she would be responsible for the bill herself. It seems that they accept insurance from the same company, but were not in her network.
When I called her insurance company to seek authorization to see a doctor here, they checked and said there were no doctors in their network within 50 miles of us. There were also no orthopedic surgeons here in their network. Basically, she can travel the 50 or more miles when the need arises or she can return to Philadelphia. I’m still hoping for a special dispensation and should hear something tomorrow. I was also told she might want to look into changing her policy to something better suited to her status and age group.
As to the first doctor bill, I’m working on the basis that they made a mistake, not once but twice, and they should eat the cost of the visit.
The Medicare she has is Part “A” and covers the hospital only not doctors visits. I checked on getting her Part “B”, but they said she had turned it down in 1992 and would now have to pay a 10% penalty for each year since 1993. That means it would cost her over $300 a month just to get Medicare Part “B” now. Did I mention she is on a fixed income? The reason she turned it down in 1992 was because she was still working for the Federal Government and already had a good insurance plan. After that she simply never thought about it again until now. The insurance plan she does have is the same one she had when she worked for the IRS.
When she turned down Medicare Part “B” in 1992, no one told her the benefits or disadvantages. When she retired, the Office of Personnel Management, did not talk to her about her insurance or the option of changing it. She was simply supposed to know these things. Let’s get serious, an answering machine confuses Mom. She is not the questioning, detailed type. I’ve been trying to find some options for her but frankly, the benefits are not easy to understand. I wish there was someplace I could go to compare different policies from different companies, side by side.
We’ll eventually figure it out, but the insurance companies should make policies easier to understand and our government should start listening to what the people are saying. While I agree we need reform, we need to get there by lowering costs, controlling lawsuits and getting a handle on the cost of prescription drugs. If we can do that, then the premiums will come down and more people will be able to afford their own policies. Beyond that, let the government expand Medicare/Medicaid to all of those who would still not be able to buy a policy of their own, but don’t mess with those of us who are happy with what we have.
