Healthcare forum offers aid for people with coverage questions

Healthcare advocates Judith Stein and Victoria Veltri answered questions and explained some currently common issues with Medicare and health insurance coverage at the forum held on Jan. 26. Photos by Steve Smith.

Ninety percent of Connecticut residents have health insurance, but that does not mean that same percentage has access to adequate healthcare, according to State Healthcare Advocate Victoria Veltri, as she spoke at a forum on healthcare at the Riverfront Community Center in Glastonbury. The Jan. 26 forum was sponsored by the Glastonbury Commission on Aging and Glastonbury Human Relations Commission.

“In Connecticut, I think we've finally realized that insurance is not the same thing as healthcare,” Veltri said. “While we work to get people covered on health insurance policies, we also have to work on reforming the healthcare system to ensure that people can access the care, that there are enough providers to provide access to a population that's aging, and to the younger population where we have to deal with chronic disease issues.

The forum was held to address common (and less-common) concerns that residents have about federal and state programs for the delivery of healthcare, as well as to create awareness of the Center for Medicare Advocacy (which aids primarily with Medicare issues) and the State Healthcare Advocate (which aids with private insurance issues) and the services they offer for residents. Both agencies are available to assist citizens in navigating their insurance plans, and to aid with what can be done if a claim is denied, or if coverage isn't granted properly.

Judith Stein, founder and executive director of the Center for Medicare Advocacy, said that in more than 20 years of existence, her office has helped return millions of dollars to families in denied care. “If things went well, we wouldn't be needed,” Stein said.

“Insurance denials happen all the time. One of the things people don't understand is that Medicare is run by insurance companies.
“We all pay premiums for these insurance policies,” Veltri said. “You ought to get the value out of that policy.

“Insurance companies are paid to make all of the claim determinations for Medicare,” Stein said. “Long story short, whether you know you've got private insurance, or whether your insurance comes from Medicare, question a denial if your doctor felt you needed the services.”

One question from the forum audience was about hospital observation status. Stein explained that a recent trend is for hospitals to sometimes hold a patient for observation for days, without actually admitting them, which changes their coverage.

“We're doing a lot about this issue,” Stein said. “Increasingly, we're seeing this problem where people are in the hospital for one-, two-, and we've had a person with a 14-day stay, and are not formally admitted. Instead, they are classified as ‘outpatient observation services,’ which means that the person has some part of the hospital bill left to pay.” Stein added that there has been a 60-percent increase in these cases between 2008 and 2010.

Executive Director of the Connecticut Commission on Aging Julia Evans Starr said her office works on public policy and research and has members who come together to promote smart public policy on behalf of older adults. “We are in the midst of an extraordinary change in how healthcare services are provided,” she said. “The same is true of long-term care. This is all happening at the same time our general population is changing dramatically.”

Starr said that while a larger number of people are becoming senior citizens, there is also unprecedented longevity. “In Connecticut alone, older adults comprise about 500,000 people,” she said. “That's huge. What we are trying to educate policy-makers about is how that is going to impact nearly every facet of society.”

State Sen. Steve Cassano (D-4), state Rep. Prasad Srinivasan (R-31) and state Rep. Jason Rojas (D-9) were in attendance, but said that they were there to learn about health insurance as much as anyone. Srinivasan said there is an emphasis on making medicine more cost-effective in the upcoming session, and Cassano said his office gets a lot of calls about healthcare issues.

“Many times people say, 'I really don't know where to turn,'” Cassano said. “Make the phone call and try to get it clarified. If something happens and you feel you haven't been treated right, we really need to know that. We can't make changes unless we know.”

Cassano also encouraged people to call the agencies, which his office often does. “What we do, is we call them, because they have the answers,” he said.

The Center for Medicare Advocacy can be reached at 860-456-7790 or by visiting www.medicareadvocacy.org. The Office of the State Healthcare Advocate can be reached at 1-866-HMO-4446.