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Health Insurance & Affordable Care Act

Patients Struggle to Learn Health Insurance Lingo

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And instead of giving him a three-month supply of medications, Yuan explained she would write a refillable prescription that would cover several months.

Gonzalez seemed bewildered.

He didn't even know he had been automatically switched to the Medi-Cal program until Yuan told him. “I knew by the news they were making some changes,” he said. “But I don’t know all the rules.”

The side effects of confusion can be harmful, providers said. Sanchez, the new Medi-Cal recipient from Los Angeles with several chronic conditions, stopped taking two of her regular medications because the doctor didn’t write new prescriptions. Sanchez concluded she didn’t need them anymore – not realizing that she was supposed to get refills.

“The concept of refill is very difficult for our patients,” said Nicole Alton, the Eisner health center’s director of pharmacy. “She is just one of hundreds of people who come and don’t understand the system.”

It’s not just low-income patients or those new to insurance who need help navigating the system.

Rob Hoerntlein, 63, had purchased private insurance before but said he is stumped by his new Covered California plan, which took effect in April.

“I still don’t understand what the costs or coverage are,” said Hoerntlein, who lives near Yosemite and is a licensed real estate agent.

When his wife had some warts burned off, he got a bill for about $300. Hoerntlein said he was told that he had vision coverage but later told he didn’t. The booklet explaining his new health coverage arrived months after signing up for the policy.

To address these problems, efforts are underway across the nation by the government agencies, universities and health plans to help people understand the language of health insurance, what services are covered and how to make the best use of policies.  The University of Maryland and the nonprofit Insure the Uninsured Project in California are among those who have offered workshops or are planning to.

Health insurance exchanges are publishing glossaries of insurance terms. Insurers are holding webinars, sending out welcome kits and trying to make everything “clear, simple and easy to use,” said Susan Pisano, spokeswoman for America’s Health Insurance Plans. Pisano added that patients will take better care of themselves if they understand their benefits.

Sat, Jun 14 2014

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