By: Beth Madden, Client Administrator, Lighthouse Lab Services
Having worked in surgical coding/billing for 30-plus years before joining the team at Vachette and Lighthouse Lab Services, I often found myself educating patients and their families on choosing a health care plan. It often broke my heart when these elderly patients had no one to help them navigate the health care system. Insurance agents would promise elderly patients the moon, but failed to mention to them they could no longer go to their preferred provider(s) and hospital(s).
I can’t tell you how many times the hospital would call me at 4:30p.m. on a Friday to tell me that they were cancelling a case for Monday morning because the hospital was out of network. I had to let the surgeon know (have you ever dealt with an angry surgeon? It isn’t pretty!) and explain to the patient that I could not guarantee I could get an out-of-network referral. These patients would tell me, “I have Medicare.” However, they did not always understand that they chose a Medicare Advantage plan that excluded the health system we were in.
If a patient had a plan that we did not accept, they would want to pay for the office visit and not file to insurance. That is a bad idea. It may sound ok for an office visit, but what if the urine sample had blood in it? That would mean more testing, including at times, outpatient surgery. Suddenly that $75 dollar office visit they wanted to pay for out of pocket would be turning into a $10,000 expense to cover the facility and physicians.
Medicare open enrollment begins Oct. 15 and runs through Dec. 7. If you have elderly parents, aunts, uncles, or friends, talk to them. If they’re thinking of changing plans, ask who their doctors are. Does their PCP refer to a particular health system when specialty care is needed? What Medicare Advantage Plans do that facility and providers participate in? If your parents like to travel, will their plan cover them outside the local network?
Take the time to ask them about what plan they have and if they want to stay with it or change. If they make a mistake and pick the wrong plan, it cannot be changed until the following open enrollment period. (FYI: If patients have dual Medicare/Medicaid plans, these may be able to be changed prior to the next Medicare open enrollment period).
This may seem like an annoyance, but trust me — you’ll be glad you took the time, and so will they!