Doctors want what they're owed by soon-to-be defunct Health Republic

The state's medical society estimated doctors are owed "tens of millions" of dollars from soon-to-be-defunct health insurer Health Republic and is calling on the state to make sure they get paid.

The federally backed health insurer is going out of business at the end of the month because of financial problems. This leaves about 200,000 New Yorkers scurrying to find new insurance for December, and doctors and hospitals worried they won't be fully compensated.

The state Department of Financial Services has put a hold on processing most claims for Health Republic to conserve assets while it investigates the insurer's financial condition -- which it said was "substantially worse than the company previously reported." So far, Health Republic has reported $130.5 million in losses. It also owes the federal government $265 million in loans.

The agency has already indicated that hospitals and doctors might not get all the money they're owed. Hospitals and doctors with Health Republic contracts are still obligated to provide services until Nov. 30 and cannot collect from consumers the amounts owed by the insurer, the state has said.

"I think it's critical that the state comes in and says it will bail us out on this," said Dr. Joseph Maldonado, president of the Medical Society of the State of New York.

In a survey of about 800 doctors, the medical society, which represents about 30,000 physicians, said Tuesday that 43 percent have outstanding claims to Health Republic. Eighteen percent said they are owed $25,000 or more and 7 percent said they are owed $100,000 or more, the medical society said.

"At the same time, MSSNY has heard from multiple physician practices that are owed . . . [up to] $5 million," the medical society said in a statement.

Last week, the Healthcare Association of the State of New York, which represents hospitals, said that Health Republic owes hospitals at least $150 million through October.

In response to a question about whether there are discussions about ensuring providers are paid, DFS spokesman Matthew Anderson said in an email: "Our first priority right now is working to ensure that the 200,000 members of Health Republic continue to receive coverage and services in the month of November and transition to new health plans beginning Dec. 1."

Maldonado said it was up to the state to ensure that doctors are fully compensated if it wants them to participate in the health care initiatives brought on by the federal Affordable Care Act -- such as the $6.4 billion Delivery System Reform Incentive Payment that will alter how health care is delivered among Medicaid recipients.

"There has to be the understanding that if a product goes belly up, you've got to be able to restore confidence and say 'We've tried this and we're going to make you whole on this,' " he said.

Health Republic was one of 23 Consumer Operated and Oriented Plans, or CO-OPs, created under the ACA to increase competition and offer low-cost health care. So far, 12 have gone out of business. Health Republic had the second-highest percentage of individual and family enrollees on the exchange -- 19 percent -- and the highest percentage on the state's Small Business Health Options exchange -- 35 percent. More than 16,000 Long Islanders enrolled in Health Republic plans from the exchange.