770-449-7369 / Fax: 770-449-1093 info@cdainc.net

 

confused pic erica post

Some time ago I was asked to consult with an individual who was struggling to qualify for medical insurance under Medicare and was facing massive medical bills without this insurance coverage.  This individual had a medical diagnosis which clearly qualified him for immediate enrollment in Medicare and yet he had not been successful in his quest.  As he described his multiple denials from the federal offices and the various roadblocks which he had tried to hurdle my blood pressure started to rise. When “What do you mean they won’t enroll you” came out of my mouth I sensed that this individual was somewhat heartened that my assessment of the situation was the same as his.

He continued his description of where he had called, with whom he had spoken and what he had been told.  None of it made sense to me and I knew I was hooked into this individual’s problem as I realized how totally incorrect and unfair this was.  But where to start?

Normally we address eligibility with the insurance carrier or the commissioner of the state of Georgia, but since Medicare is a federal program our normal state resources could not help us. Fortunately, as I quizzed my peers one of my business partners had experienced a similar run around with a federal issue in a different state.  Her final recourse was to seek help from the office of the local congressman.

I was able to recommend that the individual with whom I was working contact the office of Congressman Jody Hice and the issue was promptly addressed. The result was, not only was the coverage approved quickly, but it was also made effective retroactive to the correct date.

So what is the point of this?

First, never accept “no” when you feel that answer is not correct.  Do not be afraid of being wrong; ask anyone and everyone you can for help with issues such as this.

Second, decide where to start.  Health insurance plans fall under either state or federal jurisdiction.  Assistance needs to be accessed through different offices.

Third, thank you to Congressman Hice’s office for being accessible to the voters who they represent. We all pay taxes to provide money for appropriate claims such as this one.  It is wonderful to report something positive about an elected official when normally we only hear negative reports.