The Health Insurance Counselor

A day in the life of a Health Insurance counselor...helping to make sense of a very confusing issue...BD

Health insurance counselors like Mr. Riccardi, who travels to senior centers around New York City, help the elderly to understand coverage options and to escape the financial and medical vises that may be gripping them. Hospitals and senior centers often employ these caseworkers, nonprofit groups like the Medicare Rights Center have hot lines, and every state has a health insurance counseling program.
All day long, clients meet with Mr. Riccardi, a tall, slender man who grew up in Syracuse and learned Spanish while studying modern dance in Cuba and Mexico. He set aside that uncertain career to trouble-shoot for the elderly and to pursue a degree in social work. His clients this day are, for the most part, the retired working poor — factory workers, seamstresses, truck drivers. But for many, especially those who struggle with spoken English, the paperwork from hospitals, insurers and collection agencies, written in bureaucratic English, is beyond them. They do not understand the nuances of their plans; they pull cards from their wallets that are expired, redundant or conflicting.
Her bills are so crushing that, Mr. Riccardi believes, she may qualify for “charitable consideration” from her hospital. He helps her fill out an application. He will also research clinics and write push-back letters to collection agencies. “Didn’t they tell you when you joined that you can only go to their hospitals and their doctors?” Mr. Riccardi asks.
The clients bring in prescription slips and plastic bags of empty vials that they can no longer get refilled. One woman has 28 prescriptions. A few are floundering inside “the doughnut hole,” the coverage gap in the Medicare prescription drug plans, when recipients must pay full cost for medications. As a result, some choose medicine over food; others, food over medicine. Some choose their spouse’s medication over their own. Some split prescriptions with friends or cadge samples from their doctors. Their blood pressure and cholesterol levels are rising; complications from untreated diabetes mount.