Question: I was confused about my insurance, and my friend recommended I call you for an appointment to get it straightened out. When I called, I was told there would be a charge. I refused to make the appointment. Why do you charge for services and appointments?

Answer: I appreciate you asking the question. Sometimes people just hang up or say “No way, I can’t afford that!” I also appreciate their decision to make that choice.

The program called “Senior Life Matters” is under the umbrella of Lutheran Senior Housing. Lutheran Senior Housing is under the umbrella of Lutheran Jamestown; which includes the Lutheran Home, Hultquist Place, Warner Place, Edgewood Communities, HUD properties, and GA Family Services. That is a LOT of services provided by one organization. Each one of those services/programs provides different things to different people for different reasons at different cost structures. The Senior Life Matters program is a small part of the larger not for profit entity of Lutheran Senior Housing.

Senior Life Matters is a program designed to help individuals and their families in the community with issues related to Medicare insurance products, Entitlement programs (like Medicaid, HEAP or SNAP), Long Term Care Insurance, Geriatric Care Management, and the many options for services available to clients.

I am a Geriatric Care Manager by title. Erin Green (also in the program) is a Service Coordinator. As employees of the Senior Life Matters program, we are paid an hourly wage for what we do. We work Monday through Friday, sometimes evenings and weekends to help individuals and their families with the issues of the day.

To help with issues related to insurance and the like, there is an hourly fee charged to the individual who makes the appointment. Sometimes this meeting/consult cost is just that hour of time. Sometimes that time is a little more than one hour, sometimes it is much more than one hour.

We have found that for most appointments 1.5 hours covers the important issues and gets them resolved. There are many individuals who come back year after year to review their insurance options and alternatives. Or they come back to see us because of a different concern or problem that has come up.

In this way, it is similar to getting your taxes done. Some people are very comfortable learning the tax rules and filing their own taxes. Many individuals find that learning the tax rules is not something they want to do, and therefore pay someone else to do that work and complete those tax returns on their behalf.

When thinking of Medicare insurance options, there are other places you can go to get the get the information you need. The website, www.medicare.gov gives you a lot of the information you need to make your insurance decisions. You can also call 1-800-medicare, to get that information. Some of the information is available on other websites, such as the New York State insurance website, www.dfs.ny.gov/consumer/chealth.htm. This website has links to many insurance pricing structures and rules relating to Medicare. There are also local government agencies that can help. Office For the Aging has resources and staff available to help with some of these decisions and issues. This government program covers their cost through the taxes that we all pay to the county, state and federal government.

There are some other not for profits that provide similar services, like Southwestern Independent Living Center. Their staff can help those with disabilities to determine insurance options, entitlement help and lots of other useful assistance. This organization covers it’s costs, through donations, grants and other funding sources.

There are other individuals who provide assistance with Medicare insurance related issues, and those are Insurance Brokers. These are individuals who are contracted with insurance companies to be Brokers for the insurance company’s products. Insurance Brokers come in two types (relative to Medicare); the first includes agents that are Independent and are usually Brokers for multiple companies. This independent status means that they can talk about all the products that they have contracts with. They can compare one product to another product from different companies. The second includes Brokers who work for one company; ie- Independent health, Univera or BlueCross & BlueShield. When you visit one of those company offices, you know the agents/employees inside can ONLY talk about the product that company offers.

When you see an insurance broker, you don’t pay them for their services, because the insurance company pays them a commission for that sale. In talking with an insurance broker it is important you understand what that means, they can only talk about those products they can broker for. There may be products out there, that could be good for your situation, but if your Broker isn’t contracted with them, they can’t talk about those other products.

I do want to be clear, I do not believe ANY of these services are bad, they are all different. It is important that as a consumer you understand what you are getting and what you are paying for, and how you are paying for it.

Erin Green and I are not insurance brokers, and we are not employees of any government agency. We are employees of a Not For Profit that provides a variety of services to those who are older and those with Medicare. We attend trainings throughout the year to keep up with the latest in insurance rules and products, along with all the other parts of our jobs. We also learn through the experiences we have with our clients throughout the year. We all learn on the job, the day to day problems and issues of concerns our clients bring to us. What we learn we use in helping the next person who comes in the door.

Most individuals who call our offices, call because someone told them we could help. I am proud of the reputation that Senior Life Matters, Erin and I, have in helping people in our community. I also understand that not everyone who calls needs or makes an appointment. Sometimes a simple direction to go get the answer you need is enough to help. Sometimes individuals choose to use an alternative service that is fine. I just want you to get the help you need to answer the questions you have.

That hourly rate that is charged is used to cover the costs of operating the program, Senior Life Matters. Like every business model, there is the ‘cost of doing business’. We look forward to helping those that make an appointment. Erin and I are confident in that those we help have the insurance products that work the best for their situation now. We also know that everyone situation can change, and that maybe soon they will need something different. Many of our clients return to us year after year for an annual insurance ‘check-up”. We work with you to help find the best possible product and services to make your life the best possible.

To contact Janell Sluga, GCMC with questions or concerns, please call 720-9797 or e-mail her at janells@lutheran-jamestown.org.