THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING,
AND ASSISTANCE (NICA) PROGRAM
DECEMBER 2003 NICA NEWS
GOLD RECORDS
Bill O'Connell
In July of 2003, the NICA Program office was contacted by a couple who were receiving bills for services that they believed should have been paid for by Medicare or a group health plan. The NICA office referred the case to Bill O'Connell, a volunteer in Lincoln. Bill spent many hours working with the beneficiary and her husband, and eventually he determined that there was a major Coordination of Benefits disagreement. The beneficiary has End Stage Renal Disease, and insurance coverage through a group health plan and Medicare. When a beneficiary has ESRD, there is a 30-month coordination period during which an employer plan must pay primary and Medicare is secondary. The group plan was refusing to process any claims, and Bill spent several months and over 50 hours to resolve the issue. In the end, the group plan realized the mistake and began paying the claims. In all, Bill has saved the couple more than $200,000 in outstanding bills. The beneficiary stated that "none of these bills would have been paid without Bill's help. I can't even begin to put into words how grateful I am for his help." Bill is a new volunteer with the NICA program, but before he retired and eventually moved to Nebraska to marry his high school sweetheart, he had worked for many years as a trainer on Medicare issues in Minnesota. As is evident with this case, Bill's knowledge and experience are a wonderful addition to the program.
Pam Roberts
A Medicare beneficiary in Omaha contacted NICA after being referred to the toll-free number by Medicare. The beneficiary is a retiree from Lockheed Martin and worked for NASA for 35 years as an aeronautical engineer. The Lockheed Martin retiree plan has had several changes in their retiree plans and the beneficiary was unsure of how to proceed to receive the coverage they needed. The beneficiary and his wife met with NICA Volunteer Pam Roberts at the VIE Office in Omaha for three hours. Aimee McKim also assisted the couple. Pam helped the couple compare two of the different coverage options that Lockheed was offering, charted it on paper for them and made it easy for them to understand the differences in options being offered. For example, she helped them realize that one coverage had a $20,000 maximum benefit level and the other coverage option had a $2 million dollar maximum benefit level. After meeting with Pam and Aimee, the beneficiary went out of his way to call the NICA program office to report on what a wonderful experience it was to have these two volunteers work with him and his wife on this important issue and to help them find the answers they needed. He repeatedly expressed his gratitude for the program, and even took a brochure to post at his workplace to help spread the word to other beneficiaries about NICA.
