Berkshire Senior Online

By Sim Gaunt & Melissa James, Information & Referral Specialists

The Information and Referral (I&R) department of Elder Services of the Berkshires receives many calls during the course of the month from elders with problems or issues they are unable to solve on their own. We would like to share a few of those calls.

Avoiding health insurance confusion

One such call concerned letter received from MassHealth. The letter indicated that the elder no longer had MassHealth and she could not understand why. The I&R worker suggested that she contact the MassHealth department for an explanation of the letter and to appeal their decision. It soon became apparent to the I&R worker that the elder was upset about the letter and would not be able to ask the appropriate questions of the MassHealth office. So the I&R worker took the necessary information from the elder to make the call on her behalf.

In speaking with the MassHealth office the I&R worker was informed that the elder in question had received re-review letters that the elder was to fill out and return to the MassHealth office by a specific date. The elder did not understand the letters she received from the MassHealth office or what she was to do with them. So consequently she was no longer enrolled in the MassHealth program. In order for the elder to obtain benefits once again, she would have to re-enroll. The MassHealth representative offered to mail a re-enrollment form to the elder that she would receive in three to four business days.

The I&R worker contacted the elder with the information and explained that when she receives the enrollment form it must be filled out and returned to MassHealth. Also, if she had any questions or needed help filling out the form to contact the I&R worker. The elder thanked the I&R worker for the information and stated that her daughter would help her with the paper work when it arrived.

Another call I&R received was from an elder who was having trouble with a Medicare issue. The elder was advised to come into Elder Services so that the I&R worker could look into the matter. The elder came to the Elder Services office with a packet of information pertaining to her problem. The issue was quite complex and involved.

Help with a Medicare problem

The elder had undergone Cataract surgery 1993. Unfortunately the surgery was not performed correctly and an incorrect lens was implanted her right eye. Subsequently, the elder had to undergo another surgery for her right eye which Medicare would not approve. The reason given was that Medicare believed this second surgery to be cosmetic in nature. The elder was upset and confused and told the I&R worker that she had been going around with this issue for months and didn’t know where to turn. The I&R worker told the elder that she would look into the matter for her. She requested further information from the elder which needed to be obtained from the doctor who performed the second eye surgery. The I&R worker advised the elder that various phone calls needed to be made to MassPRO & The Medicare Advocacy Project. Once these calls were completed a letter would be drafted to send to Medicare requesting an appeal of their earlier findings in not covering her second eye surgery. The I&R worker would be in touch with the elder once the letter was completed so that she could read it over and give her approval.

The elder was very grateful for any help she could receive. The elder also stated that even if the outcome was not favorable, she was glad that there was someone there for her and who cared enough to help her with her problem.