health & wellness »
Navigating The
Healthcare
Marketplace
JFS’ Coverage to Care can make it
easier to choose the right plan for you.
Ruthan Brodsky | Contributing Writer
W
hen you hear phrases such
as balance billing, out-of-
network-liability, claims pend-
ing, retroactive denial and minimum value
cover, do your eyes glaze over? These are
some of the terms you’ll encounter (and
won’t understand) when you search online
about personal health coverage under the
Affordable Care Act (ACA).
Don’t feel bad if your brain gets fuzzy
when thinking about all the options for
healthcare coverage. According to Blue
Cross Blue Shield of Michigan, only 45 per-
cent of people understand their healthcare
plan.
Jewish Family Service (JFS) healthcare
navigators can help community mem-
bers find appropriate insurance through
the healthcare marketplace. JFS recently
expanded its effort to extend navigation
services through its unique Coverage to
Care program.
“I don’t know of any individual or agency
carrying out the Coverage to Care program
the way we’re doing it,” said Erica Saum, JFS
senior director of family life and wellness.
“Just reading a pamphlet that tells you what
you’re supposed to do doesn’t work. We
provide individual attention, taking naviga-
tion to a new level. We answer questions
over an extended time period and make
sure our clients receive coverage to meet
their needs.”
They also try to make people better
healthcare consumers. For example, Saum
said one of their goals is to help people
become comfortable getting their health
care from a primary physician rather than
running to an emergency room, which adds
cost to the program. “That takes a conversa-
tion,” she said.
BECOMING THE EXPERTS
During its first year helping clients navigate
the system, JFS staff felt it necessary to
120 September 29 • 2016
maintain personal information on clients in
order to truly help them — something not
permitted under privacy and data collection
guidelines.
“Our first step then was to get permission
from our clients to keep their information,”
said Sarit Flascher, director of health and
wellness at JFS. “That way, we could do
something as simple as follow through with
their efforts to receive coverage or help them
find a doctor.”
Flascher said that many JFS clients ask for
help following a life-changing experience,
such as finding a new job, getting married,
having a baby or becoming caregivers for a
spouse or parent.
The JFS Coverage to Care program staff
also reach out to those in the community
who might not be aware that help with
obtaining health coverage is available.
“Most of our clients don’t know that pre-
ventive healthcare is provided in their cover-
age, as is dental coverage for both children
and adults,” said Flascher, who often works
available every day to answer their
with clients whose first language is
questions.”
Hebrew.
The Jewish Dental Clinic, a
“The system can become confus-
project of the dental fraternity
ing, with prices changing yearly and
Alpha Omega, recently relocated
medical reviews often required,”
to the Bernstein Community
Flascher continued. “We frequently
Health Clinic in Pontiac, fills the
help clients complete forms and
gap for those not receiving den-
make sure documents are faxed to
Michael Zuroff, tal care from the ACA or from
the right department.”
DDS
Medicaid. Eighty participating
The good news is that individu-
dentists, 40 dental hygienists and
als don’t have to be clients of JFS
assistants together with four full-time staff
to receive assistance. Anyone who resides in
maintain the program, which has provided
the tricounty area of Oakland, Macomb and
more than $2 million in dental care ser-
Wayne is eligible for the service at no cost.
vices since its inception in March 2009.
The program is designed to support those
“Many of our clients belong to what
who are newly insured become more famil-
I call the working poor,” said Michael
iar and comfortable with their healthcare
“Mickey” Zuroff, DDS. “Some are
coverage.
Orthodox families raising five or six chil-
HELPING THOSE
dren who all require varying amounts of
WHO NEED IT MOST
school tuition. Although both parents work
Judy Teshuba of Oak Park is a client work- full time, there’s little money left for dental
ing with navigators of the Coverage to
care. We provide the family with that care.”
Care program. “I knew they would be
Helping Russian-speaking clients find an
there to answer my questions about the
affordable and effective health insurance
marketplace and help me find affordable
plan is one of Olga Semenova’s responsibil-
and appropriate healthcare coverage,” she
ities as JFS health and wellness coordinator
said.
and certified navigator.
“They guided me in making the right
“I love helping people, and helping
decisions I needed for dental coverage,”
clients understand their health care insur-
she added. “I now receive dental care
ance coverage is very meaningful for me,”
at the Jewish Dental Clinic, and I even
Semenova said.
referred a friend. It is comforting to know
I can call someone when I have a question
about my health insurance coverage.”
Want Help Choosing Insurance?
Megan Pudlik, certified navigator and
This year’s open enrollment begins in
wellness director, explained that JFS navi-
November, but you don’t have to wait.
gators speak to clients and prospective
Individuals can contact JFS at any time
clients every day. “Often our calls are from
during the year to receive Coverage to
people who never had health insurance
Care service. JFS staff will work with clients
and have no idea how it works,” she says.
for up to 120 days, during which time
“We ask them questions about the size of
they can meet in person or via telephone.
their household and their income so we
Contact the JFS Resource Center at
can match them with the best coverage.
(248) 592-2313 for more information.
We make sure they understand we are
*
Members of the Coverage to Care team:
Megan Pudlik, wellness coordinator; Sarit
Flascher, director of health and wellness;
and Olga Semenova, Coverage to Care
outreach coordinator.