One Year Later: Health Republic ACA Insurance Has Failed Me.

Posted on May 22, 2015

My name is Liz Jackson. I’m a 33 year old New Yorker. I have a chronic neuromuscular condition. And I have doctors. Lots of doctors. Who need to be paid. I am writing this post because I don’t know what to do to ensure my doctors will get paid. The issue is my health insurance. I selected Health Republic from the New York State marketplace. And they haven’t been living up to their end of the bargain. This post is a plea for help. Do you have resources? Do you have advice? Are you the Attorney General? My doctors have sacrificed so much for me. They need to be paid. And they deserve to know why they haven’t been.

Other things you may want to know. I’m smart. I’m resilient. I am well educated. I am persistent.  Seriously, I am PERSISTENT. I’m a vocal supporter of the Affordable Care Act. And a year ago, I wrote an enthusiastic and optimistic post titled 15 Days On The Obamacare Marketplace. Since then, I have failed to successfully navigate the Health Republic NY Silver plan I selected.

So if I, an intelligent 33 year old, educated adult with time and access cannot navigate the Affordable Care Act health insurance… who can? 

This is a list of email correspondences I have had with Health Republic NY. There are over 100 emails. This doesn’t take into account the calls I have made to both Health Republic, NY State of Health, Community Health Advocates and The Attorney General’s Office.

3/7/14 I spoke with a representative prior to signing up about long term continuation of coverage with an out of network doctor. She provided me with an Access to Care and Transitional Out of Network Referral Form.

4/23/14 I submitted the Access to Care form prior to start date. I cited recommendations by Kathleen Sebelius about continuation of coverage. I inquired about the process to submit and review.

4/24/14 I am notified that my Health Insurance had an effective start date of 4/1/14, even though I was covered by employee health insurance until the end of April. This requires 6 phone calls to Health Republic and NY State of Health before the situation is resolved. It took hours.

5/1/14 I’m now covered under a Health Republic NY Silver Plan

9/2014 Health Republic has not paid for May for my Out of Network doctor (who will now be referred to as OND), even though I was informed the doctor would be covered as in network per my request on 4/23/14.

9/26/14 I was told claims were paid.

10/10/14 My OND still has not received payment.

10/20/14: My OND receives payment from Health Republic in the form of a Credit Card. Seriously.

11/6/14 I can’t find an in network dermatologist, I call every dermatologist within 30 minutes, and each of them have dropped Health Republic, citing discomfort with coverage. I have to go past New York State’s 30 Minute 30 Mile law to see a doctor for a rosacea flare up. I asked Health Republic to update their dermatologists and they weren’t willing to do this.

I tell this to Health Republic:

There is the exception of [redacted] Dermatology P.C. but their reviews online consist of rudeness, pain, aggressiveness, and a mean staff.

11/5/14 I was notified that my approval for my OND was only for 90 days. I specifically had asked prior to joining Health Republic for no end date on continuation of coverage, citing a chronic illness. Health Republic said they made OND aware of this 90 day condition. OND was not made aware. I send Health Republic a copy of what OND received.

12/15/14 Health Republic says in writing they will give me until Feb of 2015 and then stop OND’s coverage. But an hour prior I had recorded a call where I was told they were going to give me limitless coverage. They acquiesce. OND is now covered. I receive a letter in writing. 

12/18/14 There’s a billing Issue. I just logged onto Health Republic to pay my bill and it went from $114 to $2127. Takes months to resolve billing issue.

1/22/15 I inquire as to why OND hasn’t been paid since we received letter of ongoing coverage.

1/25/15 Was told claims were in process.

2/5/15 OND still hasn’t received payment for October November December or January

2/6/15 I’m told claims were incorrectly declined, resubmit.

2/23/15 OND still hasn’t received payment

3/2/15 Claims denied again in error – for October 2014 moving forward

3/15/15 Billing issue with Primary Care (In Network) I keep getting charged $15 when I think copay should be $0 My card has two Co-Pay’s listed:

Primary Physician Co-Pay – $0
Primary Care Co-Pay – $15

I had assumed that since my doctor was my primary care physician, there would be no co-pay. I was wrong. I now owe $15 for every primary care visit since 5/1/2014

3/16/15 OND receives request for doctors notes. OND believes the request is illegal. Still hasn’t been paid. Health Republic tells me the request for doctors notes was an error. OND won’t see me again until she’s paid. I tweet to every member of Health Republic’s board.

3/18/15 OND gets paid for October November December and January

4/14/15 I inquire about February as OND hasn’t been paid. I am told my contact at Health Republic (who I was comfortable communicating with) was no longer in the dept and will no longer help me.

4/22/15 New Health Republic rep writes to say claims for February are still in process. I respond with a series of questions, explaining how the last time my OND’s claims were in process they were incorrectly denied. I also ask a series of questions, most notably the fairness of advertising a benefit like acupuncture on the marketplace when Health Republic pays only 9% ($8) of the bill. Take note that Acupuncture is the ONLY benefit Health Republic advertises.

Health Republic Acupuncture

(It took my Neurologist over a year to convince me to try Acupuncture. I don’t understand it, but it WORKS. But for the reason above and another reason below, I’ve been forced to stop.)

5/6/15 I write old rep saying new rep hasn’t answered any of my questions.

5/11/15 I write every Health Republic email I have. This is what I say:

I wrote 27 days ago with a series of questions and still have no response. [New Rep], if you are not able to assist me in the manner that [Old Rep] was able, will you please forward my information to someone who can?

This is 3 months after the last fiasco and I was promised this would not happen again. My doctor has not been paid since January and she is growing impatient. I was happy working with [Old Rep], I need a solution that prevents this from continuing to happen.

5/11/15 Again I’m told claims for Feb and March are still in process. I ask for clarification.

5/13/15 I receive claim numbers for finalized claims. No details on when checks will be sent. I also learn that my Out of Pocket is not $1,000 as I thought but $4,500. And my deductible is not $0 as I thought but $2,000. I scour my records for proof, realize none was ever sent by NY State of Health or Health Republic. There’s no record of what I signed up for. How can I be expected to trust Health Republic’s word?

5/19/15 NY State of Health informs me they’re not able to access the information for what I signed up for. I contact the Attorney Generals Office. Health Republic offers to make a call to NY State of Health with me. I decide to hold off and wait for AG’s office.

5/20/15 Speak with an advocate at the AG’s office

5/21/15 discover my monthly Health Republic payment has gone up (again) from $119.16 a month to $2,080.16. I also receive a letter saying I’m maxed out on benefits for Acupuncture (this is an in-network Acupuncturist, and Health Republic rejected every claim she submitted). I start this list. I’ll continue to update.

Currently, I have not had anyone speak with me about 

– Whether OND’s check has been mailed.
– The status of other OND invoices (March and April).
– Why my benefits are so low on Acupuncture (when it is advertised on the NY State of Health as a benefit). 
– Why I’m maxed out on benefits on Acupuncture when they haven’t even paid yet. 
– How I can get my OND paid on time.
– How to get my payment back down to $119.16 before 6/1/15.
– What could have possibly happened to cause such a disconnect between what I thought my out of network/deductible were and what Health Republic tells me they are. Why is there no proof.
– And who my dedicated Health Republic representative will be.
 

I have written emails begging (BEGGING) for help, for an advocate, for someone to dedicate a few hours of their time. I have begged dozens of times. There’s no asking I can do to get their attention. I have spoken with various representatives within Health Republic (including the Corporate level) and nothing works.

My OND is someone who previously would have considered carrying an Affordable Care Act insurance. But I can’t imagine she would ever consider it now, not after the blind eye Health Republic has turned to her. I will reiterate, she still hasn’t been paid for February, March or April. It suddenly seems so obvious why there are no in network dermatologists within 30 minutes of my NYC home.

So again I must ask. If I, a college educated, persistent, adult who is aware of my rights cannot navigate Health Republic’s marketplace insurance… who (WHO!) can?

One Final Note: I am also a trained healthcare advocate.

 

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What Others Are Saying

  1. Alison Emerick May 23, 2015 at 1:43 pm

    I’ve had a very similar experience with Blue Cross Blue Shield of Michigan. You could seriously write a Saturday Night Live Skit off what we have been through trying to get a plan that has 2 doctors on it. That is all. My kids’ pediatrician and my and my husband’s PCP. 2 doctors that work in the same health system. I want a plan that both of these doctors accept.
    And I agree wholeheartedly on the who can figure this out angle. I too am very educated and have worked in health care for 20 years.
    It would be comical if it wasn’t so important.

  2. Christiane Molina July 2, 2015 at 10:43 pm

    Liz,
    Medicare may be an option. Check and see if your diagnosis falls under the compassionate care allowance. Mine was — CDIP could possibly be considered fatal, even if it’s long term.
    My diagnosis fell under — Stiff Persons is considered long term fatal. I was fast tracked to Medicare Parts A&B with Prescription coverage through AARP. I receive my weekly IVIG treatments at home and go to the infusion center for Solumedrol and quarterly chemo treatments. It took some time and persistence, but I got it.

    I also got a lawyer because some of my symptoms, including cognitive damage, spasms, sight inconsistencies like night blindness and of course, periods of flare up, made work impossible. I now receive Socual Security.
    Lord knows it was easy, but it was worth it.

    Don’t give up. By the way, Medicare and Medicaid go hand in hand. Care is primary, caid is secondary.
    I wish you luck. I know quite a few with your diagnosis and it’s a rough road. There are many of us who walk it with you. In sensible shoes…and pimped out canes 🙂

  3. Alanamous August 23, 2015 at 12:33 am

    I have been chronically ill since 1999, although I have actually been ill requiring some form of healthcare the majority of my 40 years of life. I have dealt with insurance companies, doctors, ombudsman, gone through the appeals process, dealt with medical practice representative patient care advocates and have had Medicare for the past several years and dealt with their bureaucratic crap. I WISH that politicians and presidents had the exact same coverage as the rest of us lowly Americans and were forced to deal with the same nonsense so they they could realize what is going on. I honestly think that insurance companies need to be obliterated. All they are is a middle man who inflates costs, creates a need for themselves, makes more work for everybody, and doesn’t watch out for anybody but themselves. If we were to pay the REAL costs directly to our medical providers, without the bills being inflated so ridiculously, then none of this mess would be created in the first place. Except for the medications. That is another mess. Drug companies are also fleecing consumers and there is published information about the number of lies they tell to try to cover themselves to make the public think they are spending so much money on research and development when instead they are spending it all on advertising and paying themselves. Our country feeds off of anyone who needs medical help and THAT is what is sick. THAT is what we should be petitioning and fighting against.

  4. DD September 20, 2015 at 3:07 am

    I am so sorry to hear of all your troubles with these issues. Ironically I am a Licensed Acupuncturist in New York State and was researching this insurer you mentioned I came across your article and will be thinking twice before getting on board with them. If what you are saying is true about the acupuncture reimbursement issue, they are false advertising. While its great to get recognition for the fact that acupuncture does indeed work, and is a huge benefit to patients (and really insurance companies) by saving lots of money sometimes able to avoid expensive surgeries, and medications, all the while experiencing the pain relief and relaxation, and multiple benefits of acupuncture. Also having the benefit to not experience the side effects that can be a risk after a surgery that could perhaps have been avoided with much less invasive measures. Or the side effects of medications that in many cases of chronic illness but not all, do not cure, only mitigate symptoms. In an ideal situation, patients would have equal access to integrative care to enhance the benefits of each modality and provide a more comprehensive care plan for the patient. Unfortunately there is still fighting to be done to see this become a reality. As a sufferer of Lyme disease myself, and luckily having the complementary treatments at my disposal, well, since I have almost 5,000 hours of training and education under my belt for them…has been the only reason I am not one of the thousands and thousands of people that are left unable to function, or even navigate their healthcare. I just wanted to write to express my gratitude for you to put the work in to publish this article and open this discussion to include this insurer. I sincerely hope you will be provided with resolution soon, and perhaps you could find an attorney that would handle this pro-bono, or at least a law clinic that helps people navigate these issues for an income based price, or price based on resolution where you may be able to include attorneys fees within your resolution. You’ll have to contact one to find that out. Sometimes once you get a lawyer involved, things can be sped up and possibly work out better for your outcome. And thank you so much for posting the info. I will be investigating this more, nothing is more aggravating as a practitioner, when these insurers advertise your felid’s services, and then expect you to pay off your 100,000 in school loans because we are well-educated professionals with their laughable payments for our treatments which provide so much help to patients. Most all of us go into this profession because we want to help people. We spend years of our lives in school and have large student debt, and issues of our own as every human does. This company will be looked into as far as acupuncture goes, I can assure you that. I will present it to the NYS acupuncture board if need be. In fact you may want to do the same. Patients and practitioners alike need to join in the discussion to get the care and reasonable compensation that we all deserve. Good luck to you! And keep us posted!

    • Wendy February 22, 2016 at 1:43 am

      Thank you for your post! I was just looking into acupuncture and the ACA. I know that under the ACA, acupuncture is not covered in NYS. So at first I was excited to be led to this site! And then quite enraged by all that Liz has had to go through! So thank you for your detailed response! I had created a wellness workshop for one the the NYS plans, which also mentioned acupuncture. But in reality it was not that they covered it but maybe offered a discount for LAcs on their list. And well, if you were in NYC, I don’t think there really was a list…and so on and so on!

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