It all feels too big today, as the rain pisses down. Concentration may be hard to come by.
The police department sealed what was until the other day Liz’s apartment. I passed the green sticker on the door, took a blurry photo of it. Her cats, brothers Sid and Gus, were taken to another apartment where they will get fed every day and have their litter boxes kept clean, until they can hopefully be adopted.
Time marches on, rushes on, like the cold rain that is pelting down outside right now. I am going to attempt to finish the letter to the progressive, publicity-hungry Attorney General of New York, per the imagined suggestion of my dead father.
Dear Mr. Attorney General,
I am writing to alert you to a massive consumer protection failure in New York State, regarding routine denials of purchased health care by health insurance companies. I urge your office to investigate this unchecked, widespread fraud and propose legislation to correct it.
There is no New York State agency meaningfully overseeing the practices of private corporations providing health care insurance in the state of New York, as I will detail below. Even apparent outright fraud by a health insurance company cannot be redressed, except through an appeal to the insurance company itself. This letter lays out the state’s current non-functional regulatory apparatus, such as it is. I urge you to propose legislation to remedy this intolerable situation.
In January I drafted a long letter to you about this lack of regulation by New York State. The health care emergency described in that letter (and here), with consumers at the mercy of an industry rich in temptations to deny services to increase profits, is even more acute under an administration intent on dismantling all regulatory schemes. My own medical issues prevented finalizing that letter.
Since writing that draft I learned that your office proposes legislation and advocates for it. I am writing to convince you to propose a bill creating state oversight, on behalf of consumers, of the medical industries that do business in New York State. Widespread, colorable fraud is routinely committed against mandated ACA consumers/patients and no state agency oversees it.
While there are hotline numbers for aggrieved health care consumers, none of these provide any help. Alleged fraud against consumers by corporations is not something the New York State Department of Financial Services (“DFS”) is set up to investigate. The oversight functions of the Departments of Health and Insurance, you may recall, were merged into the DFS for all insurance-related purposes when New York State adopted the ACA. There is no state agency, outside of DFS, that has jurisdiction over such frauds.
New York State needs an agency to oversee routine denials of approved medical services by insurance companies and to act as an Ombudsman for the many difficulties endemic to a complicated public/private health insurance scheme.
I also urge you to call for creation of an ombudsman’s office for the New York State of Health Marketplace (“NYSOH”). I can tell you from an unfortunate wealth of experience that the NYSOH is the most intractable bureaucracy I have ever dealt with (this includes New York City’s overwhelmed Adult Protective Services and the NYC Housing Authority). The current waiting time to have an “appeal” to correct a simple clerical error by NYSOH is, at minimum, four months. NYSOH’s policy is not to divulge the identity of its director, Donna Frescatore, and I no longer wonder at that policy, with the thousands of complaints they are currently attempting to handle.
Under the ACA, in New York State, a patient is expected to resolve all issues with the corporation he pays premiums to for health insurance. I will lay out the cul du sac of non-help a NYS citizen experiences in the State of New York. It is a seemingly robust system, with numbers for consumer help hotlines. An hour’s investigation reveals that it is not even a fig leaf of a regulatory system. Presumably the only action a New Yorker can take for denial of service, after calling all of these numbers, is an Article 78, assuming one could find the legal grounds to not have it dismissed.
The health insurance company may deny services for any number of plausibly innocent-sounding reasons. Claims are denied for: errant CPT code, two numbers transposed on the NPI, wrong NPI, incorrect service code specified, something related to customer MOOP. (The PPACA is a treasure trove of acronyms).
What follows is a map of the regulatory cul du sac and some examples of this widespread silent profit-driven campaign against the most vulnerable of New York State’s health care recipients. It is my hope that your office will propose legislation to make corporations accountable for the worst of these practices.
blah blah blah…
for some reason I can’t focus much on this hideous, but important, task today.
Maybe it’s the image of a group of grinning elected white male imbeciles in suits, in a White House garden photo op yesterday, celebrating their impressive two vote “victory” in the House, passing a secret bill to abolish Obamacare.
The bill was never debated, its text wasn’t circulated before the vote, its economic impact was not scored by the CBO, but it satisfied the most implacably right wing members of the House. An actual 1930 lynch mob could not have looked more delighted, posing under a swinging corpse. The president laughed, asked playfully “can you believe it?” about him being the president. Then he set off, three hours late, to meet the prime minister of Australia and tell him that Australia’s health care system (public) is much better than America’s.
As for moving America back toward the 45,000 annual preventable deaths due to lack of affordable health care, I guess this president hasn’t had time to staff the CDC and pull down its website, as he’s already had his people do with Civil Rights and science-based Environmental information on government sites. Visit The Center for Disease Control’s site while you can.
You can read for yourself Harvard Medical School’s dire accounting of uninsured Americans’ greatly increased chance of death here. Thousands more will die, if the Republicans in the Senate can only change the rules so their 52% can pass the long-awaited law to wipe Obama’s signature legislation off the books. On the other hand, and to be fair, the incredibly rich will get richer.
We live in a country that accepts the preventable deaths of tens of thousands of its citizens a year as part of the price of freedom– the freedom of talented health insurance CEO-investor types, like Jared Kushner’s equally well-born younger brother, Joshua, who has much of his $1,500,000,000 investment fund invested in health-insurer Oscar, to reap unlimited financial rewards for their selfless service.
I’ll hope to finish my letter to the A.G. in a few days. I have to put on my rain clothes and pedal my bike through the dirty rivulets of lower Manhattan.