Medicare. How many seniors that are enrolled understand its benefits? ….. Not as many as you think. For a program established by this government FOR its seniors, they sure don’t make it easy for them to understand how to make the most of their healthcare options. The government and independent providers refer beneficiaries to Medicare to inquire about coordination of benefits between health plans and retiree benefit programs. Questions such as: “Who pays for which services first?” and “How much will I pay?” This referral system would work except for one, lousy problem…… Beneficiaries are left to remain on hold until they decide to hang up.
For what it’s worth, I think it’s important to understand, and applaud Medicare and Social Security for trying to be efficient in streamlining the customer service aspect of their business. By implementing automated systems beneficiaries can opt out of waiting for a live agent and just follow the prompts to get the desired answers to their questions. Initially that sounds great, but what if the beneficiary has a special circumstance? As in most instances when beneficiaries reach out, their questions require a full and thorough explanation, therefore making the computer-generated system ineffective. So where are the beneficiaries left to seek advice from now? Social workers at Retirement Communities, Skilled Nursing Facilities (SNF), and Human Resources departments of Employer Retiree Plans are all viable resources. They are educated enough to answer these questions. Unfortunately, however, those resources end up spending the majority of their time filing claims forms for the beneficiary. So who is left making sure the individuals understand how their Medicare options work and how Medicare coordinates benefits with their current or prospective health, employer or retiree plans? Anybody???
Would it be callous to associate this frustration to a rat trapped in a maze? I understand that may seem a bit cold, but it is really quite accurate. The answers for seniors are available but only after exhausting every avenue, which has their own fair share of obstacles and hurdles, making the process akin to the rat lost in a maze. This only frustrates beneficiaries, confusing them even more and overall makes matters worse.
What good is a system if its own beneficiaries cannot access it efficiently?
Herein, lies the problem. Many may say the responsibility of maintaining one’s own healthcare management falls upon oneself. Agreed. Individuals should not have to rely on others to make their important healthcare decisions due to the inaccessibility of designated resources. Beneficiaries want to be aware and cognizant of the options available to them and how to make the most of their choices so they can meet their individual healthcare needs. The “Designated Resources,” used to handle the inquiries about Medicare health plans, both Medicare and Social Security, respectively, are incapable of handling the demands of 80 million seniors. And so, millions go without ever fully understanding how Medicare, an integral part of their healthcare that contributes to their well being, truly works. This lack of direction, with regards to healthcare management, can be very dangerous.
Millions of beneficiaries enroll into healthcare plans without completely understanding how it affects their financial responsibility. They enroll into plans expecting a level of coverage that is different than what the insurance company will provide. Or worse yet, the beneficiaries’ projected Out-of-Pocket-Expenses for the year are far greater than forecasted. Where will the additional income come from? One begs to question where the lack of communication occurred….
The 21st century consumer market place demands delivery upon receipt. If you pay for something, you expect to get something else in return; that particular mindset is warranted. In insurance, for example, those things can be customer service, specific coverage and to pay when they, the insurance company, say they will (claims).
As a consumer, one would like to place blame on one faction versus the other, but a lack of communication could very well have stemmed from both the insurance company and the consumer. The insurance provider can make a contract so confusing, that the consumer doesn’t bother to read it all. And, well,…. just that. The consumer fails to read the ENTIRE contract or Summary of Benefits, (SOB), for those of us in the insurance industry. Therefore beneficiaries are confused as to their responsibility upholding a contract they do not understand. Hence, misunderstandings occur leaving beneficiaries confused and frustrated.
Misconceptions and misinterpretations of shared responsibility plans can lead to unwarranted claims as well. This is a major contributor to what ties up the claims departments. Claims that shouldn’t be filed are, and the one’s that should take precedence are held up, slowing down the efficiency of distributing claim payouts where they need to go. As I’m sure we can all infer, unfortunately now the individuals that are in dire need of that payout have to wait.
The insurance industry is a business, and therefore beneficiaries should approach the task of choosing a viable health plan based on their needs in the same manner, analytically and cost-effectively. By gaining a better understanding of how cost-sharing plans actually work, beneficiaries can more effectively forecast their annual Out-of-Pocket-Expenses and budget accordingly. If they are cognizant of what Medicare covers versus what they don’t cover, they are now aware, or at least in a better position to make the necessary adjustments to bear the financial responsibility, (in theory).
So then what’s the solution? Good question. What seniors need is for someone to provide an ACCESSIBLE resource within establishments and communities that will allow them easy access to the answers for their healthcare management questions. Managed Care Consultants is “THAT” resource.
Managed Care Consultants provides many different forms of educational services to the retirement community of your establishment. Through seminars, consultations, blogs and emails retirees of your institution will have 24-hour access to the answers they seek. Qualified health professionals are committed to consulting with beneficiaries about the different scenarios they may encounter when dealing with coordinating benefits between Medicare, Healthcare providers and Retiree and/or Employer plans.