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.