New kind of health care provider helps uninsured

Dina Rizzi owns her own dance studio in Huntington. But, like more than 340,000 other Long Islanders, she doesn't have health insurance and has put off routine medical care.

Recently, a student's mother recommended Rizzi, 33, look into a company called Transparent Health Network, founded by a Plainview resident. The network, begun in December, does not provide insurance.

Rather, for a monthly fee, a member can go to doctors, dentists, labs or pharmacies -- but, so far, not hospitals -- in the metropolitan area that have signed on with Transparent and have agreed to accept payments at Medicare reimbursement rates.

These fees are lower than what most uninsured patients would pay on their own. The member presents his Transparent Health Network card and pays the health care provider in cash at the time of the visit.

Rizzi loved the idea. "It gives me the chance to go to the doctor," she said. She has signed up for the family plan at $54 a month for herself, her mother and brother, who also have no health insurance. And she is offering to pay $39 a month for any of her five employees without insurance. 

Health care promise
The passage of sweeping federal health care legislation in March promises that most Americans will have access to health insurance beginning in 2014. Meanwhile, about 46 million Americans remain uninsured.

The discount health care industry, offering medical services and reduced fees, is one way those Americans can get some health care without being covered by a far more expensive health insurance policy.

According to Allen Erenbaum, counsel for the Consumer Health Alliance, a nationwide trade group for the discount health care industry, about 45 million Americans get some sort of reduced-price medical services. Erenbaum said there are dozens of discount plans available to consumers in the metropolitan area alone.

What makes Transparent unusual is that it specifically targets the uninsured, said Fred Barbra, president of the Long Island Association Health Alliance, a health insurance exchange. He said most discount health plans are adjuncts to health insurance.

Upfront with fees
In an industry that experts say is plagued with scams, Transparent's founder, Betty Heiman of Plainview, said she is trying to make her company stand out in another way: It posts fees online and has a direct relationship with providers in its network.

Heiman said her target member is someone who is working and makes too much to qualify for a government insurance program like Medicaid, or a worker who was laid off and can't afford COBRA, which allows former employees to continue their job-based insurance, but at higher costs because the employer no longer pays a share of the premium.

"This is not a panacea to the nation's health care problems," Heiman said. But "it does allow a participant to enter into the scary world of health care as a true consumer."

Heiman said she is offering the service free for a year to any uninsured volunteer firefighter on Long Island. None have signed on yet. So far, she says, she has signed on 3,000 health care providers in 30 specialties in the metropolitan area. She said members now number in the hundreds, most on Long Island.

A union signs on
But that could change. A trust fund associated with the New York Civil Service Employees Association signed an agreement on June 16 to offer Transparent to union members who are part-time and don't qualify for health insurance or who can't afford it. They would pay a price lower than Transparent's monthly fees. That's potentially thousands of union members, said Laura Balogh, director of the CSEA's health benefits department.

Balogh said she was attracted to Heiman's plan because fees are based on Medicare reimbursement rates and people can see upfront what they will pay.

"You can go online and find out what you will be charged versus someone saying you're getting 30 percent off the walk-in-the-door price and you don't really know what you're getting" for it, she said.

Doctors like the idea, too. Dr. James Albanese, of North Nassau Cardiology Associates in Glen Cove, said he joined Transparent because it eliminates the insurance company. "It really is between the patient and the provider," said Albanese.

Dr. Henry Prince, an obstetrician-gynecologist with Preferred Women's Health in Woodbury and Great Neck, said he signed up because he saw it as "a stopgap measure for the uninsured."

One expert, however, said he thought the plan was of limited value. "I don't think it's a solution," said Raymond Goldsteen, director of the graduate program in public health at Stony Brook University. "It is a little niche for people who are probably afraid to negotiate [medical fees] on their own." And when coverage for the uninsured begins in 2014, it won't be needed, he said.

Miriam Laugesen, assistant professor of health policy and management at Columbia University's Mailman School of Public Health, said she liked the network's openness about prices. But, she said, it doesn't address coverage at hospitals, where patients can run up thousands of dollars in medical bills.

Heiman said she is negotiating for in-hospital procedures with three hospitals - none on Long Island. In the meantime, she said the network provides an advocate for hospitalized members on the Island to help them negotiate lower fees.

As for changes in 2014, Heiman suspects there will be people who still won't be able to afford health insurance and will opt to pay a penalty for not having it. Transparent provides "access to affordable health care when there's not access to affordable health insurance," she said. 

Avoiding discount health care scams

Buyers beware: The discount health care industry has been fraught with scams, industry observers said.

"Unfortunately, so many plans are rife with fraud and deception, consumers are on their own to determine if they have bought something legitimate or another pound of fool's gold," said James Quiggle, spokesman for the Coalition Against Insurance Fraud.

The industry has been "very controversial," said Wendell Potter, a former insurance executive who is senior fellow on health care at the Center for Media and Democracy in Madison, Wis.

"A lot of them are here today and gone tomorrow," said Potter, who is also a consultant for Transparent Health Network. "They have frustrated a lot of insurance commissioners all over the country . . . They're like Whac-a-Mole. They go away and come back to do the same kind of deception."

But that may be changing. Allen Erenbaum, counsel for the Consumer Health Alliance, a nationwide trade group for the industry, said more than 30 states have passed laws regulating discount health care providers in the past several years, although New York is not among them.

Quiggle and Potter said consumers should read the fine print before signing up and call health care providers listed by the plan to see if they actually are part of the network.

Buyers  also should beware of: 

• Language that implies insurance is being offered.
• Hidden fees or exceptions.
• Huge discounts that seem too good to be true.
• No way to get in touch with a real person.
• Difficulty quitting the plan.

For complaints, contact the state Attorney General's health care bureau hotline: 800-428- 9071.