Do some Medicare health plans have loopholes?

Tampa - This is a crucial time for millions of seniors and disabled Americans across the country and here in the Bay area. Starting Saturday, November 15th you can enroll in Medicare's prescription drug plans. But a Tampa couple says they've discovered a loop hole in some Medicare health care plans that could cause problems for some patients.

66-year-old Barbara Crawford says she's suffered from serious heart problems for decades. When she turned 65 she qualified for Medicare so she and her husband spent hours trying to pick the best health care plan. They checked out WellCare Health Plans which is a Tampa based company. They say they were interested in the plan because their primary doctor and Barbara's cardiologist were on the provider list. Barbara says "Well when you have your own doctors you really trust them."

But her husband Bob says during a visit to their primary doctor the doctor refused to refer Barbara to the cardiologist even though he was listed in WellCare's provider directory. "And he said well Bob I don't use that doctor and I said he's in the provider list and he said it doesn't make any difference. We have our own group we use and we only use those on that group and I said well what good is a provider list?"

Bob says at that point he felt like he had a life or death decision to make. He wanted his wife to be able to go to a doctor that she already had an established relationship with. "When she couldn't go to her cardiologist that she had been going to since she was 45 years old this is when I went out and got a private plan that we're using and we have to pay for it every month."

The Crawford's are paying about $264 for the coverage and now they don't have to worry about referrals. It's money they could be spending somewhere else. Bob says he called WellCare to try to get some answers. "I went through three people before I finally got to the bottom line and that's what they said is that they had a contract with the doctor and the doctors contract superseded what our plan calls for."

Friday afternoon WellCare spokesperson Amy Knapp told 10 Connects News that "We are making contact with the member. Our customer service department is looking into what the issues are so they can be addressed immediately." Knapp did explain that there were only so many details she could share about the Crawford's situation because of privacy issues.

There is a way to get free unbiased help with your Medicare health plan choices in Florida. There's a statewide volunteer based program called SHINE. Serving Health Insurance Needs of Elders was formed in 1993 and the group says it's helped more than 800,000 people. They provide counseling on Medicare eligibility, enrollment and coverage issues. Janet Mills is an area coordinator who's been a volunteer with the organization for three years and says "We try to help educate people to advocate for themselves. Healthcare is a difficult maze in today's world and so we try very hard to help people evaluate their different options."

The Crawford's acted as their own advocates and Barbara signed up for a different Medicare health plan to meet her needs. Mills says it's something to keep in mind when you're trying to figure out which Medicare drug plan to choose from too because asking questions now could prevent a lot of problems later. She says the public needs to know there's help available whether you're trying to enroll in a health plan or a prescription drug plan.

You can contact SHINE at 1-800-963-5337.

You can also contact Medicare which has counselors available to answer your questions 24 hours a day 7 days a week. Just call 1-800-633-4226 or you can click here.