HICAP

Dealing with health insurance can be intimidating. There are volumes of paperwork to fill out, and the language can be difficult to understand.

Now, imagine that you’re in your 70s or 80s and you’ve always relied on someone else to take care of these matters for you. What would you do when an aggressive insurance salesperson calls you, or when your own physician mistakenly informs you that your health maintenance organization (HMO) is pulling up stakes?

It doesn’t take much to “trigger anxiety in seniors,” says Tatiana Fassieux, program manager for the Health Insurance Counseling and Advocacy Program (HICAP) office serving Butte, Glenn, Colusa, Tehama and Plumas counties. HICAP provides assistance with Medicare, Medicare supplemental plans and other health insurance. Trained and registered volunteers offer objective information to help Medicare recipients make good decisions about their health care coverage.

In addition to helping seniors find the right supplemental plan, Fassieux says HICAP has been effective in negotiating claims settlements with Medicare and HMOs for denied claims. In one case it recovered over $80,000 in benefits from a long-term-care insurance policy.

When a person calls HICAP with a question, an appointment is set with a volunteer at one of many counseling sites throughout the area. Sometimes problems can be resolved in a single half-hour meeting, while others require more legwork.

HICAP volunteer counselors can help clients understand Medicare, compare private Medicare supplemental programs, review HMOs, prepare Medicare appeals or challenge claims denials, explore long-term-care options and clarify their consumer rights. The one thing they will not do is endorse a specific plan.

“We cannot influence or recommend any type of insurance policy,” Fassieux explained. “We have to give them just the facts and empower the clients to make decisions for themselves based on their particular needs.”

Fassieux is concerned that many seniors are being influenced to change their health insurance policies unnecessarily. She says her office has received numerous calls about whether Secure Horizons, Butte County’s only Medicare HMO, is going to discontinue service in the area.

Fassieux is quick to point out that Secure Horizons has not indicated it is leaving. If it does plan to do so, it must notify the government agency that runs Medicare by Sept. 17 and notify its members, in writing, by Oct. 2. Members will then have 60 days to look for another supplemental plan. The letter allows them to receive coverage under a new plan without medical underwriting. Coverage cannot be denied based on answers to health-related questions.

As a volunteer-based organization, HICAP is always looking for new counselors. No specific experience is required other than a “business sense” in order to be comfortable with the required paperwork. Volunteers undergo an initial 40-hour training and internship as well as 12 hours a year of continuing education.

HICAP also offers community education programs on topics ranging from Medicare and protecting yourself from fraud to long-term-care insurance. Fassieux says her staff is available to speak to any group on these topics.

Whether it’s in response to inaccurate information or scare tactics, Fassieux suggests that seniors never change their Medicare coverage without first checking with a trusted family member or by calling HICAP. HICAP services are confidential and free of charge.