Imagine suffering a major medical crisis, only to learn your insurance company won't cover you.

It's happening to people of all ages, but especially those who rely on Medicare. 83-year-old Olive Heyward is one of them. She can't take care of herself after a shoulder-breaking fall.

“She can't bathe herself, she can't do her meals, she has difficulty getting in and out of bed, she can't drive -- things you and I take for granted she can't do,” Alison Heyward, her daughter, told NewsChannel 8.

Heyward's daughter is missing work to care for her mom, even though her mom's health insurance policy appeared to cover in home nursing care.

But Heyward's insurance company, Secure Horizons, which supplements Medicare coverage, denied nursing care.

Secure Horizons said privacy laws prevented them from talking about Heyward’s case.

“I haven't really got an explanation other that she doesn't qualify per medicare guidelines and that's not true because Medicare told me that it is covered,” said Heyward.

But even if you're denied coverage, that doesn't mean the fight is over.

Medical clinics like the Pearl Women's Center in Portland deal with patients getting wrongly denied from a dizzying number of health insurance polices.

“Within each insurance plan there might be 30 or 40 different policies so sometimes it's very difficult to council a patient about what their benefits may be,” said Dr. Richard Rosenfield of the Pearl Women’s Center.

And to make matters worse health insurance companies are not always consistent when it comes to what kinds of procedures and care they cover.

“They are not consistent,” Dr. Rosenfield told NewsChannel 8.

“They're not consistent and its important not to place blame on any insurance company or person, but we just go thorough proper channels and alot of patients don't understand what those channels are,” he continued.

In fact, the federal medicare system has become so complicated, Oregon created an agency to help patients sort through the dozens of supplimental insurance plans and their annual changes.

It’s called the senior health insurance benefits assistance program, or SHIBA.

“It's complicated,” said Lisa Emerson from SHIBA. “It's broad. We can help them navigate through the system and get them connected to a local counselor in their county.”

Those counselors are set up in every Oregon county to give seniors free advice regarding medicare insurance options.

Olive Hayward and her daughter are now getting that much needed advice.

They're appealing Secure Horizons’ decision to deny Olive's in-home care.

“We're finding this is a common thing,” Alison Heyward said. “Services are being denied to seniors.”

Many doctors are growing concerned by decisions coming from some health insurance companies.

“We're hopeful the physicians will be continuing to direct health care as opposed to the insurance companies and potentially people inside those companies who may not have as much experience in actually providing health care,” said Dr. Rosenfield.

With so many insurance options out there, it's a good idea to talk with your doctor every year about the best policy for you and your family. And if you believe you've ever been unfairly denied coverage, medical experts say don't give up. Document everything, talk to your doctor, then get ready to fight.

Medicare Appeals Information

Senior Health Insurance Benefits Assistance