InSecure Horizons

My mother calls me. Her dearest friend, 93-year old Miss Bessie, wants to know if I will look at her bills from the rehab facility she stayed in two years ago. The balance due is over $5,000 and Bessie can't understand the paperwork.

Miss Bessie is no frail, old lady suffering from dementia. Far from it. When I visited her in the rehab facility where she was recovering from a broken shoulder, she was sitting in a chair with a new Apple laptop shooting off emails to her family. She's a retired librarian and sharp as a tack. She may be 93, but she looks and acts 20 years younger.

So, at my mother's request, I, being the good daughter that I am, dutifully drive to the assisted living center where Bessie now lives and pick up her plastic grocery bag full of bills and health insurance policy documentation. I adore Bessie, but I dread this. It's like doing a jigsaw puzzle with 500 pieces and no distinct picture. It's so anxiety provoking that I make up my mind that I will not even attempt it until which time I am fully rested, calm, and in a good mood. And most importantly, when I have a window of opportunity to tackle this at work. I'm thinking in about 5 years.

It takes me about a week to psych myself up. The bag is sitting on my desk next to the laser printer. I pick it up, look inside, see all the puzzle pieces, and spread them out on my desk. I open up a new excel spreadsheet on my computer screen to enter and track the charges and I start with the rehab facility bills. ("No wonder Bessie couldn't understand these," I think to myself. "This is ridiculous!") Then I comb through the Secure Horizons contract. Then I call Secure Horizons who refuses to talk to me until I tell them I'm with a doctor's office and give them all the secret information that allows me to get past their HIPPA gatekeepers and convince them that we can discuss Bessie's billing problems behind her back. I challenge their reimbursements to the rehab facility and point out their mistakes. It turns out that Secure Horizons reimbursed the rehab facility at a different daily rate than was on Bessie's contract. There was a $800 error in Bessie's favor.

I call the rehab facility, email them the excel spreadsheet with all the reconciliation detail and wait. Three weeks later Secure Horizons sends a check to the rehab facility, but not for the full $800. I have to call them again, B.S. my way through their umpteen layers of HIPPA security and once again point out the error of their ways. And finally they pay up. Bessie gets her bill reduced by $800. She's elated. Probably more from the peace of mind knowing that she wasn't taken advantage by the rehab facility and Secure Horizons than the money itself. She pays off the rehab facility. She's smiling her beautiful smile again.

Now, you tell me, how in the heck was Bessie suppose to do this herself? What about all the other hundreds of thousands of other seniors receiving bloated bills from rehab facilities, hospitals, and doctors? There is no possible way these innocent, naive, trusting people will ever know they're overpaying. The bills are nearly impossible to understand and so difficult to dissect that I'm sure most never are.

Bessie's health insurance, Secure Horizons, is one of dozens of the Medicare Advantage Plans, marketed to seniors with the promise of giving them an advantage over straight Medicare and a supplemental plan. An advantage?

In our office, we call most of them Medicare disadvantage plans.