Red Tape

Who hasn’t been caught up in red tape? Who hasn’t been frustrated by bureaucratic incompetence? Who hasn’t wondered why customer service is no longer a priority? Who hasn’t wondered why nobody cares?

Case 1

“Janet,” a very active and proactive senior in her 70s, lives in an apartment building on a heavily trafficked residential street. A significant majority of the residents in her building are also seniors. Many have difficulty ambulating and rely on canes and walkers.

This building is located on a corner. The side street is a lovely, shaded residential street, quiet with beautiful homes. It would be a wonderful place to walk and to enjoy the shade, the chirping of birds and the multitude of squirrels foraging for food. Unfortunately, the sidewalks on the side street as well as the sidewalk in front of the building have deteriorated significantly over the years. They are crumbling, broken up by tree roots, uneven and very dangerous.

In effect, the renters in that building who have difficulty with ambulation feel shut in.

Since 2019, Janet has been trying to get the City of Baltimore to replace the broken sidewalk blocks. She’s reached out to the Department of Public Works, only to be told that the city is at least seven years behind in sidewalk repairs. Additionally, she’s reached out to her city council person for help in finding funds, perhaps grant money. Nothing came from that. She sent photos to private agencies in the area that claim interest in helping seniors be safe. No one seems willing to take on this project.

Her last attempt, a few weeks ago, was a sidewalk walk-through with neighborhood association presidents and state of Maryland representatives. All agreed the sidewalks are in deplorable condition.

Interestingly, there is available grant money to fix pedestrian walkways in the community, but the service area for these funds doesn’t include these blocks. One state delegate told Janet to contact her office in the fall. Another bureaucrat said money might be available in 2025.

While everyone talks a good story, no one seems to do anything—if you pardon the pun—concrete.

Case 2

About five years ago, my friend “Emma” moved into a newly built house with new appliances. Today’s appliances have many digital bells and whistles, which are nice but are subject to numerous headaches.

Emma’s Electrolux refrigerator is one such appliance. The compressor kept failing. Fortunately, the fridge was under warranty. The inconvenience for Emma, of course, was (1) having a new, non-working refrigerator and (2) having to plan her day around waiting for the repairman.

According to the repairman, there was an issue with the freon. Under Emma’s extended warranty, the compressor had to fail five times before the entire unit could be replaced. The repairman was out three times to fix the compressor. At a different service call, he replaced the thermistor (whatever that is!). In addition, during one service call on the compressor, he had to call the Electrolux fix-it “guru” to get instructions on what to do. Unlike the infamous Maytag repairman, the Electrolux repairman was becoming her best friend.

This went on for three months, when Emma finally convinced Electrolux to replace the refrigerator. It was obviously a lemon. Naturally, the new model refrigerator did not match the attached freezer, which has its own electronics and problems. She had to sell the perfectly good freezer to exchange it for a new one that matched the fridge.

Now, the new freezer is stuck in Sabbath mode. That’s an entirely different story. Don’t even ask.

As Emma says, “Buy GE; the extra refrigerator in the basement has been my life saver!”

Case 3

In January 2023, I discovered that my Medicare supplemental insurance policy with CareFirst disappeared from my Medicare account. In other words, providers who were paid through Medicare and were expecting reimbursement from CareFirst were not getting paid. Exchange of this information is called a crossover. My crossover data vanished into cyberspace, even though my policy had not changed and was in effect since January 1, 2022.

On January 5, 2023, I began the process of finding out why the crossover disappeared. After a lengthy wait on hold with Medicare, the customer service representative finally came on the line. He told me, “Supplying crossover data to Medicare is CareFirst’s responsibility.” That meant another phone call, and a wait, to speak to someone from CareFirst. A “ticket” was created, and I was told it takes 60 days for the data to be processed and sent to Medicare.

Sixty days! Wasn’t it just a matter of someone looking up my policy and with a few keystrokes, submitting it to Medicare? Heaven forbid the process should be that easy.

Sixty days came and went. After another round of calls to both Medicare and CareFirst in March, a new “ticket” was created. No one knew the status of the first ticket. Meanwhile, Medicare twice referred me to the Benefits Coordination and Recovery Center (BCRC). “Sorry,” said the BCRC rep, “We don’t handle that. Call your supplemental insurance company.”

Back and forth this went, with me checking in every few weeks to find out the status of the crossover. In early March, I posted on Facebook asking for a contact at CareFirst—a name of a person, a phone number or an email. A human being! Someone responded and gave me the name and email of a higher-up at the company.

She did respond, and at first seemed quite helpful. But we got stuck. In one email she admitted that CareFirst had “dropped the ball” and promised to follow up with me in a day or two. That was the last time I heard from her. On June 1, I again called the CareFirst customer service number, and ticket number three for the crossover was created.

Meanwhile, my providers were not being paid. Luckily none of them threatened to call a collection agency.

A few days after the June 1 phone call, I decided to contact the Maryland Insurance Administration. Its website has an easy-to-use form for medical insurance complaints. I filled it out and pressed “send.” It wouldn’t go through. Two more tries were just as unsuccessful. Not my day.

Now, it was time to bring in the “big guns,” my Congressional Representative. I’m on John Sarbanes’ email list, and he always writes he’s available to help with Medicare problems. So, I called and left a message. Two days later, someone from his office returned my call saying I don’t reside in Sarbanes’ district. My congressman is Kweisi Mfume. Oops.

Finding a phone number for Cong. Mfume online was not easy. However, I did find email contact information. It took four days for someone to respond, but the lady who did has been very helpful. She contacted Medicare and wrote me it would probably take 30 days to get a response. Fortunately, after only two weeks, she heard from them. But, they told her what I already knew; the crossover data has to come from the supplemental insurance company.

She said not to worry, she had a contact at CareFirst. Last Thursday night (third week in June), she emailed me an “authorization form for information release” from CareFirst. I promptly filled out the forms and sent them back. I decided to give this issue a few more business days. If nothing got resolved, I’d call the Maryland Insurance Administration to register a complaint.

Friday afternoon, Ken, my husband said to me, “Why don’t you check your online Medicare profile page?”

“What’s the use?”

“You never know; maybe something will show up.”

Around 4:30 p.m. this past Friday, I logged onto Medicare.gov. Scrolling down the page where my Part A, B and D insurers are listed, is another box entitled “other insurance.” Lo and behold, there it was, finally in black and white: CareFirst, coverage start date 1/1/2022. Eureka! It only took over six months to fix this!

Addendum

It’s Sunday afternoon and once again I’m on my Medicare profile page. Now, I have two boxes that read CareFirst, coverage start date 1/1/2022. Does that mean my providers are going to get paid twice for each visit? I won’t be surprised if a third box appears. After all, CareFirst reps created three tickets to recreate the crossover.

The next battle will be getting the unpaid claims paid.

Please leave your comments below.

Read more by Eileen Creeger.