2 largest health exchange insurers face criticism

Some patients enrolled with the two companies that captured the largest percentage of customers on New York's new health insurance exchange -- Empire Blue Cross Blue Shield and Health Republic -- still do not have coverage and have had difficulties getting medical treatment, patients and brokers say.

Their complaints have prompted a probe of one of the companies -- Empire -- by state Attorney General Eric T. Schneiderman.

As of Jan. 26, the latest available figures show that 351,605 New Yorkers have enrolled for private insurance plans on the New York State of Health exchange, according to the state Department of Health. Long Island had the second-highest percentage of enrollees in the state, with 21 percent.

And many of them are unhappy.

"It's been a nightmare," said Louis Drucker, 62, of Centerport, who has an Empire plan. "I have a pile of paperwork bigger than the ACA [Affordable Care Act] itself."

Typical complaints include: still not having ID cards; being given the wrong ID numbers; being assigned primary care physicians they didn't sign up for; having to send in payments for coverage without having been properly billed or knowing whether they actually have coverage; learning their payments have been lost; discovering that their doctors don't actually belong to the plan. And spending hours on the phone trying to disentangle it all.

Schneiderman's office sent a letter to Empire Jan. 14 and met with company officials on Jan. 17. "We have reason to believe that many individuals still have not received any verification of insurance coverage," the letter said. The letter said it was "unacceptable" for Empire to ask people to pay premiums when they were being told they had no proof of coverage.

One couple's 'nightmare'This was Drucker's experience. After getting no notification from the company that he and his wife, Beth, were signed up, he was told to make his first payment to "generate our bill."

He said he sent a direct wire transfer, which was cashed the same day. A week later Drucker called and was told that the check was lost and, until it was found, the couple would have no health coverage.

A month later, he said, their membership cards came but listed the wrong primary care doctor and ID number -- which meant his wife had to cancel a doctor's appointment. After hours on the phone, Drucker said, he got an email Thursday telling him that his plan was "perfect."

"All I can say after all of this is, 'I sure hope so!' " he said. He said they are still waiting for their new member cards.

The attorney general's office would not comment on the Empire letter or meeting -- or whether it was also looking at other insurers -- but Empire, which garnered 18 percent of the state's health exchange market, said it was working closely with Scheiderman's office and other state agencies.

"Empire takes our commitment to delivering quality service very seriously -- and we know that a number of our members who purchased individual plans sold on the New York State of Health marketplace have not gotten the kind of customer service they expect from us -- and that they deserve," Empire spokeswoman Sally Kweskin said.

The insurer was unprepared for the sheer volume of new customers, Kweskin said.

"What we perhaps underestimated was the onslaught of New Yorkers calling in very late December to sign up for health coverage effective in January," she said. "The call volume was really unprecedented."

Kweskin said that in early January over a two-day period, WellPoint -- Empire's parent company -- "responded to one million calls, which is the average amount of calls it normally fields on a monthly basis across all of its businesses."

Similarly, Debra Friedman, Health Republic's chief executive, referred to "the unprecedented number of enrollees." Health Republic captured 16 percent of the health care exchange.

Working to fix problemsBoth companies said the situation is improving.

Kweskin said that "ID cards are moving out the door and our January subscribers have received their premium payment letters."

In addition, she said, the company has extended its call center hours; increased staffing; extended the payment deadline to Jan. 31 for the first month's premium; allowed temporary IDs to be printed online; and allowed members to pay by phone, mail and online.

Friedman said Health Republic has also added staff and phone lines and extended hours in order "to manage the high call volume we have received."

She said "nearly all ID cards for Jan. 1 coverage have already been sent to those members that joined by paying their initial premium, including thousands in Long Island."

But that may be little comfort to insurance brokers.

Neil Weingarten, vice president of Conference Associates in Patchogue, said the firm's chief operating officer has been working round the clock to deal with problems, most of them with Health Republic.

"There's a lot of conflicting information," he said. "I just think, in fairness, they are overwhelmed."

Sharon Washwick, business manager for The Washwick Agency in Riverhead, said she has been working up until midnight every night trying to resolve clients' problems.

"We're losing clients because they don't see what we're doing is helping them," she said.

One of those clients is Carolyn Bennett, 43, who has multiple sclerosis and requires IV treatments every 28 days to keep her symptoms at bay. Formerly of Manorville, she now lives in New Paltz and her ex-husband pays for her insurance.

She got an Empire plan for $566 a month. On Dec. 18, she said, the agency sent in her check for her premium. But about 10 days later, she said, Empire said it had never received her check and that it couldn't process the application without receiving payment.

"After Washwick kept calling and calling and calling," Bennett said, she got a call last week from an Empire representative saying the company still could not accept her as enrolled because -- although it had a scanned copy of the check -- it didn't have the actual check.

She said she still doesn't know whether she has been approved for coverage.

Without approval, she had to delay her monthly IV treatment, which costs $5,200 out of pocket. Luckily, she said, the drug company was willing to pay for the treatment once.

But she said she has had to put off other treatments and she has run out of some prescription drugs.

"I'm a walking time bomb now," she said.

'Playing with our lives'Dolores Persky, 51, has gone through similar anxiety.

The Wantagh resident has breast cancer that has spread to her lungs and she requires monthly chemotherapy treatments as well as other medications.

She signed up in October with Empire, for a plan that cost her $940 a month, cheaper than the $1,400 she had previously paid. She didn't hear from the insurer until December when it sent her a bill for $1,400 with the wrong ID number. After she called the insurer she got another bill for $200 "and I knew that wasn't right."

But the bigger problem was with keeping her doctors.

Persky said she had carefully looked to make sure they -- especially her oncologist -- were on the plan. But when she went for her monthly chemo treatment weeks ago she was told that her oncologist was not on the plan -- and neither was her primary care physician, cardiologist or, in fact, any of her doctors.

And under her new plan, she had to get a referral -- quickly -- from a new primary care physician for the chemo treatment. What ensued were days of anxiety and hours on the phone with Empire.

It turned out that the oncologist would accept her plan. She never got the referral, and Empire has since said it will give her a permanent referral for the chemo. The insurer also gave her a three months' continuation of service with her cardiologist after which she will have to find a new one -- although he is still listed on the website as accepting her insurance. But she had to find another primary care doctor and pay out of pocket for her daughter's visit to a neurologist.

"Something is really wrong with this system," she said. "They are playing with our lives."