Fred Mogul, Reporter, WNYC News
Fred Mogul has been covering healthcare and medicine for WNYC since 2002.
State senators on Monday grilled the state official in charge of the New York state health exchange – and they got an earful from consumers, doctors, insurers, brokers and advocates.
Several members of the Senate Health Committee relayed complaints from their constituents on everything from lack of Spanish translation to unclear listings of eligible doctors and hospitals.
“I’ve had people tell me over the past month that they’ve been on the phone for more than 12 hours, over a couple days,” said Senator William Larkin, from Rockland County. “There’s something missing.”
Dr. Patricia McLaughlin, an ophthalmologist from the Upper East Side, testified that she had long accepted many plans from Empire Blue Cross Blue Shield and was surprised to find herself dropped from its network. At the same time, she also held an Empire plan for herself and her husband and her employees, and she discovered their physicians were no longer in-network, either.
“Every single one of us were losing our doctors – 100% of our doctors,” she said.
Insurers testified that companies indeed have been limiting the doctors and hospitals patients can use, as a way to control costs.
McLaughlin and others complained that it has been difficult to determine which providers are in-network with various health plans.
Donna Frescatore, head of the state health exchange, said the state thoroughly vets insurers to make sure their networks are adequate.
“Some plans came to us, and their provider networks were not thorough enough in certain counties, and those plans were not certified,” Frescatore said.
Sen. Kemp Hannon, from Long Island, chairman of the committee, said he thinks plans should offer out-of-network options, perhaps as add-on ‘riders’ to existing plans. Frescatore and insurance industry representatives said it would be difficult to do that and also drive down healthcare costs.
“We are aware that there are some individuals who would prefer a product with an out-of-network benefit,” she said. “We think in the end that strong, quality plan networks really is the answer for most consumers who need both predictability for out-of-pocket costs and premiums that are more affordable for them.”
During testimony, the state also released its first breakdown of who has been enrolling. About one-third of them are under age 35, and one-third are over age 55. Experts say there generally needs to be a heavier proportion of young to old for the exchanges to be viable, but they say three months of enrollment does not provide enough information to determine which way things are going.
The federal Department of Health and Human Services also released figures for exchanges, including states that opted to let Washington set up their insurance programs.
Since the debut of the exchanges in early October, 156,902 people in New York and 34,751 people in New Jersey have signed up for private insurance coverage.