May 14, 2024

Does My Health Plan Cover That? (Fraudsters Beware!)

Rick Lee
Time Read
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mins

Does My Health Plan Cover This?

At Healthrageous, our mission is to make life easy for the older Americans we serve. Initially in 2021, we began with nutritious, prepared meals. Now we are tackling social isolation, highlighting our commitment to addressing the loneliness epidemic as a core health issue. We call ourselves a digital healthcare firm for seniors, yet we are not involved with conventional healthcare issues like broken hips or prostate issues. Where we see the opportunity to make the biggest impact is where the needs are greatest.

In the employer world, where 155 million Americans receive their healthcare coverage, a similar resetting of priorities—away from conventional medical care to making life easier—has been occurring in the employee benefit category. Family issues contend with provider networks for primacy in the minds of a majority of employees. 

Consider these factoids from the 10th Annual Modern Family Index:

  • 24% of parents surveyed in 2024 say they would be nervous to tell their bosses they have to miss a work event to make a family commitment, compared to 39% in 2014.
  • The proportion of employees with kids who are afraid to ask for reduced hours dropped from 43% in 2014, to 22% this year.
  • Those fearful of asking to work remotely also fell from 43% to 21%.
  • 46% of working parents say they want help paying for child care, 40% want unlimited remote work, and 45% want more flexibility.

We call the phenomenon in today’s workplace a search for work/life balance. Since most seniors don’t work, the balance we seek is between maintaining our health and thriving in life. (This mirrors the changing workplace dynamics, emphasizing the importance of holistic approaches to health and well-being.)

Don’t get me wrong. I am not advocating for an approach that ignores a woman’s broken hip or dismisses a man’s high PSA scores and meddlesome Benign Prostate Hyperplasia (BPH). But social isolation is a medical issue. It significantly increases the risk for heart disease, stroke, and dementia. It can be as potent as 15 cigarettes a day. Yet a physician may be more troubled by a senior’s continued dependence on nicotine and tobacco than on their social isolation.

Now, perhaps, it's more understandable why we focus on non-medical issues that can significantly affect our health. After all, stress lacks a diagnostic code, but surely intrudes on our collective happiness.  One major stressor for us seniors is the constant intrusion by dishonest commercial vendors and fraudsters into our lives, causing chaos and increasing our anxiety. To address this, Healthrageous is actively working on creating specific solutions designed to protect seniors from these threats, thereby fulfilling our mission to reduce stress and improve the quality of life for our clients.

More than 15,000 seniors were defrauded last year. In 2020 alone, we Boomers reported 88,262 instances of fraud and lost more than $3.1 billion to financial fraudsters, including romance, lottery, and sweepstakes scams. We are also targeted for identity theft and credit card fraud.

To think that there is a toll-free National Elder Fraud Hotline in the US. Really? Why is “Elder” in the title? Because we are disproportionately singled out and abused. Are we too trusting? Perhaps. Do we need to go back to school to learn how to identify and deflect such intrusions on our made easy life? Not in your life or my lifetime. So is the answer to grin and bear it? I hope not.

Let me cite an example of a large corporation that has chosen not to solve the problem versus a large health plan which would like to be more protective of its Medicare Advantage membership.

A screenshot of a phoneDescription automatically generated

Verizon has been marketing a solution for our problem of being victims of fraudsters who use our land lines and phone numbers to exploit our naïveté. I believe the most help Verizon could provide would be to honor and strengthen the Do Not Call Registry, which applies to all telemarketers. Even better, interdict the scam artists’ business models. But this Fortune 500 company has another idea – offer you a second line that is not (yet) known to the fraudsters. Great. We pay more money and Verizon shows they are trying to solve OUR problem. I think not.

Then there is Highmark which has recently announced a new partnership with the Federal Bureau of Investigation. And you ask why is Highmark swimming outside its lane of being a health plan? Because they appear to be taking the job of making life easier for seniors seriously. “The devastating effects of these schemes go far beyond financial losses, robbing people of their sense of security,” said Agent Rojek from the Pittsburgh office of the FBI.

For health plan executives, making your MA Plans easier to use and more consumer-friendly will go a long way in setting your plan up for success. (This strategic focus not only protects seniors but also enhances your competitive edge in a rapidly evolving healthcare market.) The social determinants of health have a much greater impact on the overall condition of one’s mind and body. By devoting all of your resources to the body, you are missing an extraordinary opportunity to protect “elder” victims from mendacious fraudsters and by so doing mitigate the persistent stress and anxiety that are byproducts of identity theft and scams.

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