Solving problems and doling out information all in a days work for SHIP program specialist
When Judy Leivas, 71, had a problem getting Medicare to pay for her chiropractic visit, she visited the local Western Arizona Council of Governments office to ask for assistance.
"Someone suggested I come here to get help with my problem," Leivas said as she began showing Doug Eubanks receipts and paperwork.
Eubanks, a State Health Insurance Program specialist who works though the WACOG Agency on Aging, has counseled thousands of seniors about how to get more bang for the buck when it comes to health insurance.
"Seniors are faced with some tough decisions when it comes to their health coverage," said Eubanks, who has worked at the Region 4 WACOG office in Kingman for three years.
"It can be complicated and confusing."
Even though Leivas has Medicare, she also works part time and has health insurance through her employer.
Medicare pays for chiropractic visits, but bills must first be submitted to Leivas' primary insurance company.
If the insurer denies the claim, she must submit the denial to Medicare, Eubanks said.
"This is a big problem with seniors still working.
A lot of providers automatically bill Medicare first," he added.
"If seniors are on Medicare it is assumed they are retired and have no other coverage."
Another problem solved, but Eubanks said there are hundreds more like it, some more serious than others, including a client whose wife was billed for six doctor visits while hospitalized in Las Vegas, even though she had been seen only once by the doctor.
Other problems stem from confusion, rather than fraud, Eubanks said.
"Around here there are a lot of retirees who have coverage through previous carriers," he said.
"When they switch carriers, claims can be billed to the wrong company.
It is very important to let someone know when you have switched."
Health care became an even greater issue in Mohave County when one health maintenance organization went bankrupt and stopped doing business in the county altogether more than two years ago, leaving some seniors without coverage.
"People move into the area from where they have been on an HMO and find out we don't have that in Mohave County," Eubanks said.
"There are a few health care choices, but not many."
Those below the poverty level can apply for the Arizona Health Care Cost Containment System, he said.
There is also Medigap for those who want coverage for some of the gaps in Medicare.
Besides co-payments and deductibles, some Medigap policies cover medicines, a big expense for many seniors, Eubanks said.
Low-income seniors who qualify can purchase needed medicine for just $15 with a new program available through Pfizer, a global pharmaceutical company.
Other cards to ease the cost of medicines are becoming available, he said.
In addition to free counseling he offers Medicare beneficiaries, their families and caregivers, Eubanks counsels groups of seniors at the Kathryn Heidenreich Adult Center about new programs and legislation related to health insurance.
Information on applying for Social Security, Medicare and other programs, as well as long-term policies, is also available.
He is also involved in "Ferret Out Fraud," a state program designed to prevent Medicare fraud and abuse.
"Medicare fraud costs all of us in Arizona nearly $1 million a day," Eubanks said.
"This means less money for health care."
The Area Agency of Aging coordinates services and programs funded through the older Americans Act in Mohave and other counties.
The mission of the agency is to support senior independence and quality of life, Eubanks said.
Programs are designed to help people 60 and older.
For more information, call WACOG at 753-6247.