Thinking Inside the Box: Medicare


In the last few weeks, I have been on the phone many dozens of times trying to sort out my 81-year-old mother’s health insurance. When she moved 52 miles, from San Francisco to live with us in San Jose, California, my mother had to change doctors and insurance coverage. As I understand it, the Medicare rules provide for a 30 mile radius around your home address for allowed health providers (except in emergencies and special circumstances). Getting her address and coverage transferred turned out to be very complex, so much so that my mother asked me for help in sorting out the mess.

Shortly after my father’s death in November 2011, my mother moved in with us. She thought she followed the rules and notified the right people of the move but soon started receiving NOTICE OF DENIAL OF PAYMENT letters from her health insurance company. Because she no longer permanently resided in the coverage area, she was disenrolled in her Medicare program and her doctor bills went unpaid.

Since then, I have talked with many staff members at my mother’s Medicare supplement insurance (“Medigap”) provider, sometimes several times a day. Some have been officious and bureaucratic, others have been thoughtful, supportive, and energetically helpful. In the past few weeks, we have managed to get her insurance reinstated and we are now discussing the effective date for coverage in our area. My mother gets letters almost every day giving complex and sometimes conflicting information. For example, on 10 February, there were two letters: one confirming disenrollment and the other confirming receipt of enrollment papers. Yesterday, there was an unsolicited 12″ x 9-1/2″ x 4-1/2″ box full of paper: instructions, lists, and rules documents. In my Silicon Valley world, these kind of documents only exist in electronic form.

In 2009, I wrote about my son’s $163,613 hospital bill as a specific example of how very broken the financial side of America’s health system is. My mother’s Medicare rules box and associated correspondence, which would mystify anybody even if they were good at paperwork and in excellent health (not the target audience for this material), seems to be another great example of a sadly broken system.

Image by Katy Dickinson 2012 Copyright

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Filed under Home & Family, News & Reviews

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