Fred Mogul, Reporter, WNYC News
Fred Mogul has been covering healthcare and medicine for WNYC since 2002.
Last weekend, Rob Cuillo had a severe stomach bug, and began thinking it might be time for a trip to the emergency room near his home in Ronkonkoma.
“I was sick as a dog, puking my brains out,” he said. “I was so dehydrated, I was thinking if this goes on another day I might need an I.V. to give me some liquids.”
But then he remembered he hadn’t received his insurance card from Empire Blue Cross. He had enrolled in the plan through the New York State of Health, the state exchange for purchasing coverage under the Affordable Care Act.
“It said I was enrolled, so I thought I was enrolled, but I kept waiting and waiting and waiting for my insurance card or to hear something from the company,” he said.
People have been complaining for months — on Facebook and Twitter and elsewhere — about New York’s state insurance exchange. The problems have been similar to those nationwide: crashing web pages, long wait times on phone lines, customer service representatives who promise to help and then don’t deliver.
But in recent weeks, most companies in New York appear to be processing enrollments smoothly — and now complaints are centered almost exclusively on Empire Blue Cross.
Empire Blue Cross refused to be interviewed, but in an email attributed the problem to “attracting the largest number of consumers in New York.” Neither Empire nor state Health authorities would discuss the underlying technical problems – or disclose how many people have been affected. Donna Frescatore, is the head of the New York State of Health marketplace.
“I don’t have a ballpark number, but I certainly think it’s enough – we’ve heard it enough time to know that it needs immediate action,” Frescatore said, while also acknowledging the problems are not recent and date back at least to November.
A couple days after his stomach virus ran its course, Cuillo got a letter in the mail, telling him the premium and how to pay it online. But the website wouldn’t open.
“I can mail it in to them, but I feel a little uncomfortable sending a check in the mail to people who don’t answer the phone,” Cuillo said. “How do I know it’ll even get there?”
The Community Service Society, one of many private organizations around the state helping people enroll, has managed to fast-track coverage for individuals who need immediate medical treatment.
“I think we were all surprised that New York’s blue-ribbon carrier is the carrier that’s had, apparently, the most bumpy of roll-outs,” said Elisabeth Benjamin, the organization's Vice-President of Health Initiatives. “I think a lot of folks enrolled in Empire because of its incredible reputation, and everyone’s a little flummoxed about why these problems are occurring.”
Empire spokesperson Sally Kweskin, in her email, said the company is adding phone operators, expanding business hours and mailing out letters to customers telling them they will receive invoices and ID cards as soon as possible.
Frescatore says Empire customers will get extra time to pay their first bill.
“If an individual applied by the December 24th due date, and they pay their premium within 10 days of receiving their invoice, their coverage is retroactive to January 1st,” she said.
But some customers have said that’s too little too late.
“We're done,” Sean Hayden told WNYC.
Hayden was an Empire policy-holder for many years and gravitated toward it again when he went on the exchange to purchase new coverage. He then spent more than six weeks trying to confirm he and his partner were enrolled with Empire, before giving up and going with a cheaper rival plan from newcomer Health Republic, a spin-off of the Freelancers Union. The final straw was realizing nearby Mt. Sinai Hospital wasn’t in-network for Empire Blue Cross, as he had expected.
“If we had eventually gotten the policies with Empire, the irony would be we wouldn’t even be covered under the hospitals we were trying to be a part of," Hayden said.
Empire refused to answer questions about its hospital network, but in a private email obtained by WNYC, a representative said the company would be using the same provider network on the exchange that it does with other plans — something Empire does not appear to be doing, according to navigators and insurance brokers WNYC spoke with.
Frescatore said insurers are allowed to have different networks for different product lines — and they can drop or add doctors and hospitals at will, as long as they maintain an "adequate network" to serve customers.
“We understand the expectations of consumers, but networks are fluid, and from time to time in a plan year the providers affiliated with a plan can change,” she said.
She said the Health Department is currently conducting a quarterly review of insurance networks for adequacy, and she had no reason to believe Empire dramatically altered its list of providers.
Enrollees have until the end of March to sign up for 2014 coverage. They can change plans before that, even after paying the first premium – but they need to check the fine print to make sure they will not have any gaps in coverage.