Been away from this thing for the duration of the Clinton/Obabma Wars....
As I stated before, this blog will surely just turn into a file cabinet of borrowed / lifted articles and anecdotes of things we ( I ) should not let slip my mind. We are bombarded daily with at least 2 or 3 of them. Real press stoppers! And folks just go about thier business like nothings wrong.
Well, anyway, from an article in the NYT's today about "The Health Insurance Counselor".
Just the fact that we NEED someone called a Health Insurance Counselor is a sign of things being in pretty sad shape. Socialized medicine my ass! Just keep making these companies richer fox news folks, just keep working your ass off for em... Oh yeah, little tidbit on Osama bin Ladin this morning, some kind of rift between the|White house ( that would be Cheney) and the CIA?...Hmmmm, Really?
From the NT Times:
Doggedly Persistent, Untying Medicare Knots for the Elderly
The client, a retired fabric cutter who looks older than his 66 years, slumps into a chair and empties a shopping bag stuffed with unopened envelopes, prescription slips and sheaves of official nasty-grams onto the counselor’s desk.
He manages an abashed shrug at the mess. The man is not feeling well; it has been weeks since he has been able to take his medications for hypertension and gastrointestinal disorders.
“The pharmacy says my insurance don’t cover,” the client explains, alternating between Spanish and tentative English during his appointment at the Isabella Senior Resource Center in the Upper Manhattan neighborhood of Washington Heights. With a combined monthly income of $1,050 from a pension and Social Security and rent of $800, he has had to forgo the medicine.
Frederic Riccardi, 32, an attack dog disguised as a health insurance counselor for the Medicare Rights Center, a nonprofit organization based in New York that assists recipients nationwide, lunges for the pile. After sorting the materials into Urgent, Eventually and Confetti, Mr. Riccardi calls up the man’s Medicare prescription plan and does a search on the Internet.
Indeed, the list of drugs on his plan doesn’t include three of his essential medications. “If your doctors want you to get your medicine,” Mr. Riccardi tells him, “they need to write your insurance company saying these prescriptions are ‘medically necessary.’”
He adds as he types, “I’m writing examples for them.”
Then Mr. Riccardi, who is bilingual, urges the fabric cutter to ask the doctors which private Medicare plans they accept so he can help his client figure out which of 45 such plans best meets his medical and pharmaceutical needs.
Ah, now, here’s a puzzlement. The fabric cutter is also enrolled in a state prescription-assistance program that should have helped defray the cost of the uncovered medications. He would still have to pay $20 per prescription, a hardship certainly, but at least not full price. So why didn’t it kick in?
Mr. Riccardi calls the pharmacist. The pharmacist says he is suspicious of secondary billing and doesn’t believe the state plan will pick up the tab.
Then Mr. Riccardi gets a state plan representative on the phone. He conferences the two in.
“So, sir,” Mr. Riccardi says, at last, to the pharmacist. “My client has a bunch of prescriptions. Can I send him over now to pick them up? Thank you!”
As the client departs, ceding his seat in a full waiting room, Mr. Riccardi says: “Do not leave the pharmacy without your medications. Call me if you can’t.”
This is high season for Medicare madness. Advertisements for insurance companies saturate the media; recruiting vans park outside senior citizen centers. Through the end of December, recipients may choose among dozens of prescription plans. In January, enrollment begins for private Medicare plans.
If only it were that simple. In addition, a recipient may weigh the advisability of supplementary coverage and charity programs; master the fine print of loopholes, deductibles and co-pays; track shifting rosters of physicians, therapies and medications; and try to anticipate new frailties in the coming year. Dental work? Wheelchair? Oxygen tank?
Health insurance counselors like Mr. Riccardi, who travels to senior centers around New York City, help the elderly to understand coverage options and to escape the financial and medical vises that may be gripping them. Hospitals and senior centers often employ these caseworkers, nonprofit groups like the Medicare Rights Center have hot lines, and every state has a health insurance counseling program (www.shiptalk.org).
All day long, clients meet with Mr. Riccardi, a tall, slender man who grew up in Syracuse and learned Spanish while studying modern dance in Cuba and Mexico. He set aside that uncertain career to trouble-shoot for the elderly and to pursue a degree in social work. His clients this day are, for the most part, the retired working poor — factory workers, seamstresses, truck drivers. But for many, especially those who struggle with spoken English, the paperwork from hospitals, insurers and collection agencies, written in bureaucratic English, is beyond them. They do not understand the nuances of their plans; they pull cards from their wallets that are expired, redundant or conflicting.
“Do you answer the phone?” Mr. Riccardi says with a jesting smile to a tiny woman with frosty hair, as he sorts her envelopes. She has old bills from Medicare, collection notices, coordination of benefits snarls and new bills. Her husband, a retired hotel guard who now has Alzheimer’s, is in a nursing home; her daughter is fighting colon cancer. She herself is not in great shape, but at least she is physically and mentally able to reach out to a Mr. Riccardi.
“I just keep the answering machine on,” she replies, trying to laugh, because he has discovered her little secret. The tears well up suddenly. “It’s too much,” she whispers.
Her bills are so crushing that, Mr. Riccardi believes, she may qualify for “charitable consideration” from her hospital. He helps her fill out an application. He will also research clinics and write push-back letters to collection agencies.
“You have to take care of yourself,” he tells her. “Don’t worry about this.”
With faceless bureaucrats over the phone, Mr. Riccardi is polite but forceful: “Is it possible you can ask your supervisor to access that information?” But even an attack dog will bounce off a wall built of absurdities: “The call volume is too high, so you can’t answer my question now?”
By early afternoon, Mr. Riccardi, who has worked through lunch, buries his head in his hands. “I. Have. A. Headache,” he mutters.
The clients bring in prescription slips and plastic bags of empty vials that they can no longer get refilled. One woman has 28 prescriptions. A few are floundering inside “the doughnut hole,” the coverage gap in the Medicare prescription drug plans, when recipients must pay full cost for medications. As a result, some choose medicine over food; others, food over medicine. Some choose their spouse’s medication over their own. Some split prescriptions with friends or cadge samples from their doctors. Their blood pressure and cholesterol levels are rising; complications from untreated diabetes mount.
If you must choose between paying the hospital or the pharmacy, Mr. Riccardi advises some, pay for your medications so you can get better. The hospital can be paid in increments.
The next client, a disabled truck driver, is confused and worried. The hospital where he had cornea surgery on one eye now refuses to operate on the other, saying it doesn’t accept his insurance. What happened?
Mr. Riccardi peruses the jumble of cards, trying to figure out the man’s current insurance. He should be receiving Medicare and Medicaid, which would give him entree virtually everywhere.
“What’s this?” Mr. Riccardi asks. A card for the driver’s new private Medicare plan.
“Didn’t they tell you when you joined that you can only go to their hospitals and their doctors?” Mr. Riccardi asks.
The client shakes his head, bewildered.
Mr. Riccardi asks him why he picked this plan.
“They picked me,” he replies. They signaled to him on the street, he says in Spanish, and invited him into their van.
“O.K.,” Mr. Riccardi says, tightly, through his teeth. “Let’s get to work.”
