Last night as I’m huddled into a chair speaking to a Medicare Ombudsman, my brow furrowed deeply, worrying about the hour I had a startling realization.
I was speaking to someone in Phoenix.
One of Medicare’s most important functions is located in the Valley of the Sun. Medicare call centers are staffed 24/7. Ombudsman are a M-F 7am-9pm responsibility. As I’m explaining the obscure strange path Emblem Health has cobbled together in Suffolk County I feel kinship.
I’m strangely apologizing for the time. It is 9:01pm EST.
As I offer, “Oh. I’m so sorry. Your shift is ending. I know you have to get off the call.”
They pause. “It is only slightly past six pm here in Phoenix.”
My shoulders immediately lowered. They had already been softening up during the short exchange we had. I was curious: What lengths did a Medicare Advantage plan consumer have to extend themselves to effectively complain? (Were some journals going to be enough? I have a hybrid of computer and notebooks.)
But really, did anyone care?
I’m not skilled in the matters of filing and tracking a grievance. Navigating the healthcare system can create intense migraine headaches. I wanted a helping hand.
I was so surprised by the voice, the concern, the offer to help.
My goal for the remainder of this year is to most efficiently assist my parents. I want them to live warm, enriching lives. I don’t want them to spend hours worrying about referrals, delayed durable medical equipment or how to obtain a prescription override. I don’t want them to be stressed about … paper.
But in my gut I know it is wrong to expect a senior to do – This. Whatever this set of hoops our family has been jumping through. I find it curious that there is a technology and education level required to have speedy access to medical care. (Paying Medicare $104 + Emblem $122 a month is not free. My parents should not need to be faxing referrals between offices. Just getting to a doctor, the lab and the pharmacy is a sufficient adventure.)
Being told by specialists, “Oh. I’m sorry.” (With a head shake.) “You won’t be seen for months with that health insurance. Are you sure you can’t switch? Anything would be better.”
I intentionally used the plural form of specialists. In February I polled our collective team of specialists for Mom and Dad. There were damning, vigorous nods of, ‘Yes. Drop it.’ But as the realization there was a choice only dawned on me days before the dis-enrollment window ended, I was screwed.
Vulgar words.
But when a family has one (well, in our case, two) dysfunctional systems in place there is a love hate relationship. We had the fear of the unknown in front of us. Making the decision for two in less than three hours was too much. I went to bed and closed the door on the option to change. (If it had been just me, I would have jumped off the diving board into the pool, holding my bathing suit tightly. A little bit of boobage is ok once in awhile.)
And so, the recap:
My parents should not need an outside advocate to ring multiple Emblem Health partners to access their benefits. My parents – Your Parents – should not need a translator-social worker-yenta to interpret their health plan. A doctor should be able to treat them. Perhaps I’m naive in thinking that, but I don’t think an insurance company should be the one telling the doctor what to do. (Or, what not to do.)
I rang Medicare to learn how to document Emblem Health’s hiccup points. A grievance filed with focus on Health Care Partners for Dad was reviewed and closed. I question how that is possible given the amount of administrative time required on my end. As this continues to be a trend with Mom I had to ring someone.
Phoenix answered the call. I moved to Phoenix for the weather. It continues to beckon me.
I miss it.
It may hold some of my very important clothing accessories hostage (and unparalleled physical training opportunities). But Phoenix also is home to many, many call centers 🙂
Thank you mysterious Phoenix friend for listening!
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