NY insurance exchange gets mixed reviews at sign-up deadline

Mary Calamia sits inside the living room of

Mary Calamia sits inside the living room of her Holbrook home on Monday, March 24, 2014. Mary signed up for health insurance with Health Republic and they overcharged her about $4000. She's still having trouble getting the money back and has spent hours on the phone. (Credit: Steve Pfost)

Assessing the success of the state's health insurance exchange is a relative thing as Monday's 2014 enrollment deadline for coverage approaches.

Doctors remain frustrated with lingering uncertainty about which networks they are in. Many insurance brokers say they still have a hard time getting answers from insurers.

Consumers who early on complained of an array of problems, ranging from being assigned primary care physicians they didn't sign up for to billing screw-ups, say their problems have for the most part been addressed -- although many remain leery of just how good their plans are.


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But insurance companies that participate on the exchange -- even those such as Empire BlueCross BlueShield and Health Republic that have faced criticism for backlogs and delays as they contended with thousands of new members -- say they are pleased and surprised by the number of enrollees and intend to offer plans on the exchange next year.

And from the state's perspective, the exchange has been a genuine success.

More than 780,000 New Yorkers have enrolled in the NY State of Health, part of the federal Affordable Care Act, since it opened Oct. 1, the state announced Friday. Of those, 65,000 enrolled last week alone as people continued to sign up before the deadline for coverage this year. New York has the third-largest number of enrollees nationwide, after California and Florida, according to a March 11 report by the U.S. Department of Health and Human Services.

Of those, more than 70 percent were previously uninsured. That is well on the way to the state's goal of 1.1 million enrollees by 2016, according to the state Department of Health.

About 53 percent of enrollees qualified for Medicaid, the state said. And, according to a Kaiser Family Foundation report released Thursday, 176,000 New Yorkers enrolled in private plans have qualified for tax credits worth an estimated $466 million.

Compared with the glitch-plagued federal exchanges, New York's website, despite some early delays, has been relatively problem-free. On Tuesday, federal officials said that those who started their application on the federally run exchange, Health Care.gov, which sells plans in 36 states, would be able to enroll past the Monday deadline if they had technical problems signing up. No such extension was made in New York.

"I think the experience has been really great," said Lisa Sbrana, counsel for the NY State of Health. "We've seen an outpouring from all over the state."

Sbrana said the exchange has been making adjustments to the website since its launch and has added call center specialists so that the wait time is now about two minutes.

"We want it to be the easiest experience for consumers and to really make it user-friendly," she said.

 

Seeking improvements

Insurers have pledged much the same thing. On Wednesday, about 325 attendees at the New York Metro Association of Health Underwriters meeting in Manhattan heard a panel from eight insurance companies answer questions from brokers. The five on the panel who participated in the individual exchange this year said they all intended to be back next year, and that they would work to make it an easier experience for all.

J.P. Galaris, president of the association, said that was good news. "Any legislation, especially this legislation, will have unintended consequences," he said. "We need the federal and state governments, insurance carriers and the brokerage community to work together."

Insurance brokers said their lives were far less hectic than several months ago when they were trying to sign up clients for coverage that began Jan. 1. But many said they still were frustrated by not being able to get clear answers to their questions from some insurers.

Asked what his sense of how well the exchange has worked, Steve Sekur, an independent agent in Seaford, said: "It depends on who you talk to. If you had nothing [no health insurance] before and you're getting tax credits, something is better than nothing." But, he said, he continues to have problems getting his phone calls and emails answered for those clients with specific issues. "It's still a nightmare," he said.

Empire, which has had the highest percentage of enrollees -- 18 percent -- in February ended up having to offer three weeks of free coverage to some consumers who signed up for health insurance by Jan. 1 but didn't get care for several weeks because of enrollment problems.

Sheila Talty, Empire's regional vice president for marketplace exchanges, acknowledged the difficulties the insurer had faced.

"The plans, the provider networks, the formularies and the whole exchange concept itself was new to everyone, and because of that there was clearly a 'breaking-in' period," she said in a statement. "Yes, it's been a bit of a roller-coaster ride for insurers, physicians, brokers, policy-makers and consumers most of all -- but that said it's also been an extraordinary time for the uninsured and a transformational time in the history of health care."

 

Customer experiences

Health Republic, a newcomer to the marketplace that garnered the second-highest number of enrollees -- 16 percent -- also faced its share of criticism from members.

One was Mary Calamia, 51, of Holbrook, who found the insurer erroneously withdrew $4,904.49 instead of $494.49 from her bank for her monthly premium. After many stressful hours on the phone and calls to legislators, she said the error was ultimately corrected.

In response, Health Republic has since changed its protocols to prevent such an error happening again, the insurer said, and it has quadrupled the number of phone lines to its call center and increased staff.

The insurer said in a statement it has been "working diligently to enhance our customer service capabilities in response to the extraordinarily high demand."

Other newcomers, Oscar and North Shore-LIJ CareConnect, have had fewer enrollees, but both said they had exceeded their projections.

Spokesman Nick Rosen-Wachs said Oscar will have more than 13,000 members, "significantly" above its original projection of 7,500.

"The first two weeks of March have been the best two weeks ever . . . and we're convinced the last two weeks will exceed those," said Oscar co-founder Kevin Nazemi.

Alan Murray, chief executive of North Shore-LIJ CareConnect, said the company had projected it would sign up 6,000 members and was close to 8,000.

"We have been pleasantly surprised by the response of customers," Murray said.

One of those is Michael Perivolaris, owner of a kitchen and bath remodeling company in Franklin Square. Not only was North Shore-LIJ's silver plan among the cheaper options, he said, most of his 35 employees live in eastern Queens or western Nassau and already use doctors that are part of the health system.

"It's been a smooth, almost seamless transition," he said.

For others, less so.

Noreen Laiso, 56, of Oceanside, said she had until this year been paying Emblem $850 a month for her policy, which she liked. But it was canceled when it didn't meet the standards of the Affordable Care Act and she enrolled in another Emblem policy, a platinum plan for $629 a month with a $2,000 deductible. In mid-February she slipped on ice and broke her ankle in two places and was told she needed surgery.

But, she said, the orthopedic surgeons listed on Emblem's site said they didn't take her insurance and, after days of fruitless calls, she ended up being referred to a hand specialist. On her way with her daughter to see the hand specialist, her daughter spotted an orthopedic surgeon's office and ran in to see if it would take her mother's insurance. It did and the surgery was a success.

But the experience left Laiso with a bitter taste. "I had a perfectly good policy," she said. "It's heartbreaking to see what all this is coming to."

 

Some unhappy doctors

Many doctors couldn't agree more.

Dr. Raymond Ebarb, president of the New York Academy of Family Physicians, ticked off a half-dozen reasons why he and his 5,300-member group were unhappy with the exchange and favor a single-payer system, such as in Canada, or Medicare for all.

For one, he said, many doctors were not included in plans they thought they had signed up for. He said he had lost about 60 patients from his busy West Sayville practice, although many said they had meticulously signed up with policies that listed him as part of the network. Conversely, many physicians were learning they were included in plans they had never heard of.

He said reimbursement rates were lower, and that in many cases, even prescriptions for generic drugs required prior authorization -- a time-consuming task for doctors. But then he paused and added:

"One thing that is positive. When people come in and you ask them if they have insurance, those people that never had it and now do, they have a big fat smile on their face. That's a nice thing."

NY State of Health

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