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Reader comments on supplemental insurance coverage

Published: 10:10 PM, 10/12/2012

Source: The Newport Plain Talk

Dear Editor:


I want this to be a lesson to anyone who has private medical insurance, including supplemental insurance plans for Medicare.

I was recently hospitalized for a grueling, extensive, and intensive decompression and fusion surgery to my lumbar spine. I ended up having some significant problems with nerve pain that set back my recovery and extended my hospital stay. My patient case worker promised to find me a rehab center where I could gain more ability to get around based on the needs of my home circumstances. A couple of afternoons later a woman skittered in and out of my room like a flash, leaving a brochure on my bedside table.

When I later looked at the brochure I was impressed. The supposed founder of that "Skilled Nursing Facility" (hereinafter called "A") had been a sports medicine doctor and the facility had a strong emphasis on physical therapy.

The next afternoon I received a call from another "Skilled Nursing Facility" (hereinafter called "B"). That representative made it sound as though the facility she represented was even more capable of providing me with any physical therapy I might need. Later the same afternoon she called me back to tell me her boss had reminded her that I had a co-pay. She told me I had to pay $2,300 up front. I told her I had been reviewing another facility, named "A", and she told me that they would charge me even more. I thought that was pretty strange. I asked her, "And what if I only stay a few days, when will I get my money or the balance of my money back." She said, "Oh, you'll probably have it in 30 days or so." That was not an answer that sat well with me.

After I had pondered things for awhile I realized that I was being told that two different facilities planned on collecting two different "co-pay" amounts. That made no sense to me.

Sure enough, the salesperson from "A" called me, almost as though on cue, and told me my "co-pay" would be $3,100 - payable up front! I didn't bother to ask her anything - I just thanked her for letting me know and hung up.

I called my insurance company. Only "B" had even called the insurance company, and no one had verified that I had no co-pay for the first 7 days in a skilled nursing facility. The insurance company representative said, "I won't tell you that you can stay in the hospital indefinitely, but if you feel a few more days would help - and be less frustrating than the skilled nursing facilities, I suggest you stay in the hospital a few more days, since you still have time." She agreed with me, that no matter what those two facilities were telling me about care, after their initial contact I could not trust either of them to do anything but put me in a bed and feed me - for as long as they thought could keep me in their facility. I ultimately went home two days later, and am receiving regular physical therapy.

If you have any private insurance plan, please check with your insurance company about your coverage. I don't suggest hauling your big insurance plan information books with you to the hospital since someone from their customer service department will be just a call away. Don't give anyone a "co-pay" of any kind unless you know that such a co-pay exists. I just wonder, and very sadly, how many people are taken advantage of in situations like this when they are most fragile and least able to be their own advocates.


Jeanne M. Daniels

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