CINCINNATI -- Navigating the health insurance maze became a second full-time job for a Northern Kentucky woman trying to take care of her father.
Karen Humphreys started dealing with her dad's insurance company in January. She has his power of attorney, and said she's spent the past six months going round and round with his insurance company over 24-hour care a doctor said her father needs.
"It's just frustrating," she said. "I feel like I'm beating my head against the wall. If I get a different person, I get a different answer."
It's a problem that experts say is all too common for seniors.
Her dad, 84-year-old Lee Ampfer, is an Army veteran and career lineman for Cincinnati Bell. He fell in his Northern Kentucky home last October and suffered a brain bleed. Humphreys started dealing with his insurance company in January. The next month, Ampfer's doctor diagnosed him with dementia and signed an order requiring him to have round-the-clock care.
Humphreys said representatives from Anthem Blue Cross and Blue Shield in Ohio told her Ampfer's policy covered non-skilled in-home health care, which can include services like housekeeping, running errands and grooming.
"I talked to so many people at Blue Cross Blue Shield that I didn't believe them," she said. "I said, 'You'll pay for this?' I was kind of in shock. That was on January 23. I called them back on January 24 and I made them tell me again."
But by June, the insurance company had changed its tune, further confusing Humphreys.
"She's telling me, 'Well, that might not even be covered.' I said, 'What do you mean it might not be covered? So now you're really backing out?'" Humphrey said.
To make sure her father got the care he needed, Humphreys dipped into his savings account to pay for it while working with the insurance company to figure out reimbursement. The total out-of-pocket expenses through the end of June was about $65,000.
"I don't have a money tree in my backyard," she said. "I don't know what they think I'm going to do."
Unable to get consistent answers from the insurance provider, Humphreys reached out to the 9 On Your Side I-Team for help.
After the I-Team asked an Anthem Blue Cross and Blue Shield spokesman about Ampfer's coverage, the family got a resolution.
Jeff Blunt, the public relations director fo Anthem Blue Cross and Blue Shield in Ohio, provided the following statement:
"We always strive to provide our consumers with access to the best medical care according to the terms of their health plan. The services in question are not a covered benefit under Mr. Ampfer’s health plan, nor are they covered by Medicare. We took a closer look at the circumstances of this particular situation and made the decision to cover the services Mr. Ampfer has received to date."
Humphreys was relieved the company is finally reimbursing her dad roughly $65,000, and will pay for his non-skilled in-home health care coverage through the middle of July. She said she hopes to never have to wage that battle again, but she's prepared to if needed.
"I know they think I'm going to give up," she said. "I'm doing it for my dad. I'm fighting for him.'
Humphreys is not alone in her frustrations. A 2018 market research study from J.D. Power found that, overall, customers are less satisfied with insurance plans, struggle to understand how those plans work and want better customer service.
Miriam Sheline, an attorney at ProSeniors in southwest Ohio, said they handle about 6,000 calls across the state each year. The the most common issues are debt and medical-related debt.
"The confusion with regard to medical coverage is a huge issue," she said.
ProSeniors also gets calls from families like Humphreys' in Northern Kentucky, but they have to refer them to legal aid because they're out-of-state.
Sheline said there's nothing in place to make navigating health coverage easier for seniors.
"It's a matter of seniors, when they start enrolling in Medicare, to really understand what their insurance covers and who they need to talk to at each state," she said.
Sheline also said Humphreys did the right thing by documenting every bit of communication with her father's insurance company even though the process was frustrating. Humphreys was able to show she was told several times her dad's care was covered before she was told it wasn't.
Humphreys said her dad got his first reimbursement check from the insurance company last weekend, another check arrived earlier this week and more are coming soon.
Here are some resources to help seniors and caregivers navigate private and government-assisted health insurance coverage:
- ProSeniors Legal Hotline
- Ohio Department of Insurance
- Ohio Senior Health Insurance Assistance Program (SHIP)
- Ohio Senior Medicare Patrol
- Legal Aid Society of Southwest Ohio
- Kentucky Department of Insurance
- Kentucky Senior Health Insurance Assistance Program (SHIP)
- Kentucky Senior Medicare Patrol
- Northern Kentucky Legal Aid