Tag Archives: policies

Legal Advice: The Right Time for a Professional

Long View: Leaving Some Things to the Professionals

I have to admit the health insurance business is complicated and often difficult to understand. So many regulations are involved, and then there are the exceptions, annual plan changes, and the wide variety of policies that are available.

We help our Health Alliance members navigate the wonderful world of health insurance every day. Another arena that seems especially complicated to me is the law.

In central Illinois, there are resources for people who need legal advice for civil cases (not criminal), which are provided at no cost to those who qualify. One of these is called Prairie State Legal Services. Its mission is “to ensure equal access to justice and fair treatment under the law by providing legal advice and representation, advocacy, education, and outreach that serve to protect basic human needs and enforce or uphold rights.”

Adrian Barr is the Managing Attorney for Prairie State. He told me, “The legal system is a very difficult place to navigate for people who do not have attorneys. It is almost as if we in the legal community speak and write in a different language.”

“Having the opportunity to consult with an attorney about one’s legal situation can be an invaluable resource,” he said. “Prairie State will discuss a person’s legal situation with them and provide legal advice. Prairie State will also provide representation for important legal issues, including those that affect a person’s finances, safety, housing, or their health.”

Lora Felger is my co-worker in Iowa. She is very sharp, but knows legal questions are best left to the professionals. Lora suggests Iowans start with their local Area Agency on Aging. Iowa’s 6 regional Area Agencies on Aging partner with Iowa Legal Aid to offer free legal services to eligible seniors with the Legal Assistance Program. This program “serves persons 60 years of age and older by providing legal advice and representation, information and education, and referrals in civil legal matters throughout the state.”

I think I will have to be satisfied with my expertise in the field of health insurance. I feel justified in my decision to let the professionals handle any legal question that might come up. My personal experience also tells me it would be prudent to use a professional electrician whenever the need arises. I accidentally created an arc welder one time, but that’s a subject for another column.

Patrick Harness is a community liaison with a long history of experience in health insurance. If you ask him to pick a color, he always chooses orange, and he is known for his inability to parallel park.

Community Care

Vantage Point: North Central Washington Cares

At a North Central Washington event I heard someone say, “Show me a community, a place where people care for their elders, and I will show you a good place to live.” Whether I am going to a senior networking forum in Chelan, Douglas, Grant, or Okanogan counties, conducting Medicare education, visiting one of our provider offices or collaborating on a fun event, I find NCW continues to grow as a place that recognizes, respects, and strives to enhance the quality of life for our seniors.

I recently had an opportunity to listen as Bruce Buckles, Aging and Adult Care of Central Washington’s executive director, presented on federal and state policies that impact seniors and adults with disabilities. Afterwards, I realized that with a rapidly aging population, as well as the daunting costs of diseases, such as Alzheimer’s, it is more important than ever to support programs that care for and benefit the aging.

We can’t always control what happens with laws, but on the local level, it’s a privilege for Health Alliance Medicare to partner with lots of outstanding, proactive agencies in caring for our seniors.

This month, Health Alliance Medicare is honored to join many other Grant County senior networking agencies to hold the inaugural Columbia Basin All-Senior Expo and Picnic. The free event will include a catered lunch, fitness demonstrations, raffles, door prizes, education, and fun entertainment all to celebrate Grant County seniors.

I have a favorite saying, “Regard the small as important and make much of little,” so I was excited when I saw a toddler, just starting out in life, looking up at a stage taller than herself and mirroring the steps of seniors at a Stay Active and Independent for Life geriatric fall prevention class during a recent health fair.

May we always look up to our elders, recognize and respect what they have to teach us and remember we are also aging and have the power today to help strengthen our communities by making sure we have adequate resources, programs, and health care. If we can do that, there is no doubt NCW will continue to thrive as a good place to live and age.

Your Insurance Team's Support

Vantage Point: We Work Together to Support You

Painted in the stairwell of Samaritan Hospital is an inspirational message, “All of us, for each of you.” The same can be said of our Health Alliance Medicare team in North Central Washington that works together to provide elevated customer service for members and our provider partnerships.

Eileen, our program assistant, is the first face members see when they visit the Wenatchee office. Eileen feels that by supporting staff and prioritizing tasks, she can focus all her attention on members when they come in.

“Health Alliance isn’t just insurance coverage,” she says. “It is a place to come if you have questions, are seeking information, or would just like a cup of coffee and an ear.”

Jessica, our bilingual customer service representative, says, “The most rewarding part of my job is having the ability to see our members face to face, build relationships, and let them know I am here to listen and help.”

Through her role at Health Alliance, Teri, our customer service lead, hopes to insure our members only have good experiences when adverse situations arise. Teri credits the overall team from claims to medical management for its support in helping her achieve her goal.

Major procedures, hospitalization, surgeries, and discharge plans all need prior approval, and Cindy, our utilization review nurse on the medical management team, uses her experience in risk management, coupled with patient advocacy, to take care of our members through major health issues, thus controlling unnecessary costs.

Medicare is not only complicated for our members, it can be complicated for providers as well. Therefore, Leslie, our provider relations specialist, works directly with clinical staff members to help them understand policies, procedures, and operating systems. By providing face-to-face customer service at the provider offices, it makes providers’ jobs easier, positively impacting their care of our members.

The Centers for Medicare & Medicaid Services ranks Medicare Advantage plans on a five-star scale, and factors within that quality scale relate to providers assessing, managing, and controlling chronic conditions. Amanda, our coding consultant, works directly with physicians to provide coding education and finds it rewarding when she and the doctors learn something from each other, ensuring overall great health care to our members.

Whether they’re working with members or providers or making medical decisions behind the scenes, these are just a few of the local people committed to working together toward the common goal of ensuring quality of care, setting Health Alliance Medicare apart in North Central Washington.