Nebraska Department of Insurance
THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM
MARCH 2001 NICA NEWS
GOLD RECORDS
Record 10/00 (B. Stiles): Client will have her 65th birthday in February. She is trying to determine what to do about health insurance. She is eligible for a Medicare "Carve Out" policy from her (deceased) husband's former employer. This policy provides prescription benefits, but not as much other coverage as a Medicare Supplement policy. She kept trying to have the Volunteer tell her what to do. The Volunteer was afraid she was going to make some rash decisions she would later regret. The Volunteer suggested that, perhaps, we should go over the options with someone in her family and they could help. We met with her daughter-in-law who seemed to understand the problems and suggested that the family discuss the matter when they were together for Thanksgiving. The Volunteer told them if they wanted to go over the options any more to call her. (Time=3.5 hours; $=0; Satisfied=unk)Good job of remaining objective, NICA Volunteer. The client must be the one to make the decision. Even well-meaning attempts to persuade a client to do something of which you are absolutely confident, can backfire. The client must always make their own choice, even if you feel it is the wrong one.
Record 12/00 (J. Meyer): The medical/administrative staff at a nursing facility told the beneficiary that a second brace might not be paid for by Medicare. The NICA Volunteer called CIGNA, the regional Medicare carrier for claims for durable medical equipment and supplies. The brace will be paid for if the physician's prescription/notes state that it is medically necessary for the broken bone. (Time=1 hour; $=$0; Satisfied=unk)
Don't forget CIGNA has a toll-free number you can call, 1-800-899-7095, which can help put the beneficiary's mind at rest.