Julie Sneider
View from the Waiting Room

Cutting through the red tape

By - Apr 5th, 2010 04:00 am

illustration by Brian Jacobson. Original photo by “Jackal of All Trades” via flickr (cc)

Do you ever feel overwhelmed, befuddled, totally frustrated with the maze of rules and restrictions of your health insurance? Trying to figure out what is or isn’t covered, when to make a co-payment or discerning what does or does not apply to your deductible can be daunting, especially when you are ill.

Harder still for some consumers is navigating the obstacle course of government agencies when trying to determine eligibility for public health benefits such as Medicaid or BadgerCare.

Help with cutting through such red tape may soon be on the way. Wisconsin state legislators are considering a bill that would set up a statewide network of benefits counselors to advise people younger than age 60 on their health care coverage options.

If passed, Assembly Bill 878 — and its counterpart Senate Bill 633— would assist Wisconsin families and individuals in applying for and keeping health care benefits. The new network would be similar to the state’s existing community-based patient advocacy models for people over age 60, senior citizens covered by the federal Medicare insurance plan and the disabled.

Introduced March 19 by state Rep. Donna Seidel (D-Wausau) in the Assembly and co-sponsored by state Sen. Mark Miller (D-Monona) in the Senate, the so-called “Family Health Benefits Bill” has the support of the Wisconsin Department of Health Services, as well as the state Office of the Commissioner of Insurance and Advocacy & Benefits Counseling (ABC) for Health Inc., Madison.  So far, the Assembly and Senate health committees have held public hearings on the bill.

Wisconsin has consumer advocates to help senior citizens with questions about Medicare, so it makes sense to set up something similar for younger families and individuals who lack health insurance and don’t know how to get it, says Bobby Peterson. Peterson is the public interest attorney and director for ABC, a nonprofit law firm that links children and families to medical care benefits and services.

“Many under the age of 60 experience complex and convoluted health care coverage issues at the worst possible time — when they or a loved one are ill,” Peterson says. “Still others are eligible for programs that are too difficult to understand without individual advocacy.”

And when those families or individuals feel so overwhelmed that their medical bills go unpaid, personal bankruptcy is often the result, he says.

The bill would have the Department of Health Services award $250,000 a year to an oversight organization that would set up the statewide network of benefits specialists ready to assist consumers in finding and enrolling in health care coverage. The counselors also would assist consumers in filing appeals if they are denied insurance eligibility or if they’re denied coverage of medical services. The oversight group would seek federal and other funding sources to support the counselors’ work.

While the counselors would primarily assist low-income people eligible for government insurance plans, it’s envisioned that they also would be available to advise younger consumers who are seeking insurance for the first time, particularly as the new federal health law unfolds and requires all Americans to have health insurance by 2014. The counselors’ work would not supplant the role of agents or brokers who sell private insurance, however.

Peterson says the federal health reform law is complicated and will be confusing for many people to figure out — all the more reason to “prioritize actions that help people obtain and maintain health care coverage” as soon as possible.

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