Death By Corporate Bureaucracy

A cautionary tale about conservative, industry-drafted half-measures to protect all citizens from death due to lack of health care, a human right, particularly in a country as wealthy as ours. [1]  

I had a call from my nephrologist’s office yesterday.   Due to the pandemic, the doctor is doing telephone visits only.   Would I like to keep my appointment for next week?   If so, I’d need to take a blood test two or three days before.   We made the arrangements, since it is a good idea to keep an eye on a potentially fatal kidney disease that seems to be in remission. 

An hour later I got a call from the Insurance Verification Unit of the hospital the doctor works for.   The woman informed me that I came up as uninsured.   As we spoke she ran my Healthfirst ID number again — insurance inactive.   That’s not possible, I told her, I had a hassle with the insurance company in January, but that’s all been straightened out, no gap in coverage, premiums paid through June.   She told me to check with them and call her back with the update, or else I’d have to pay the full uninsured price for blood tests and the telephone visit with the doctor (non-negotiable retail prices nobody can tell you in advance, of course).

I called Healthfirst.   After a rocky first start where I antagonized an agent named Cat by brusquely instructing her to call my doctor’s office and tell them my insurance was in effect, resulting in being placed on hold for fifteen minutes, I called back.   The second rep, a pleasant woman named Annie, responded immediately, in her heavily accented English, to my gentler query.   “No,” she told me within a few seconds, “your insurance was cancelled on March 31.   We didn’t do it.   It was the New York State of Health, you have to re-enroll with them.”

Annie informed me that a month earlier, on March 11, 2020, days before the pandemic epicenter where I live went into lock-down due to the public health emergency, The New York State of Health, sole purveyors of Patient Protection and Affordable Care Act insurance in New York State, sent Healthfirst a notice that my insurance would be cancelled effective March 31, 2020.   No reason was given.  I was paid in full and she could see I’d re-enrolled for 2020 prior to the original December 15 deadline, having done so on December 6.   Annie told me I needed to call New York State of Health and immediately try to re-enroll.

“Why didn’t Healthfirst notify me three weeks before my insurance was cancelled that I’d better get busy if I wanted to remain insured in April, during a pandemic?”

“It was not Healthfirst, it was the New York State of Health, you have to call them, we cannot call them for you,” said Annie, helpfully.   She explained that it was a law, she didn’t know which one, or maybe a policy, that prevented Healthfirst from being able to help me keep the insurance I’d paid them to provide me.  She just knew that, unfortunately, Healthfirst couldn’t do anything to assist me, it was up to me to work it out with The New York State of Health.

I called the New York State of Health Marketplace, the most opaque, overwhelmed and incompetent bureaucracy I have ever encountered (and I spent years dealing with Adult Protective Services and NYCHA two infamous paragons of overwhelmed inefficiency) .   This is what I heard:

Thank you for calling the New York State of Health, for English press “1”

New York State of Health is experiencing high call volume.  Because of the public health emergency we are extending the due date for people who are expected to renew before April 15.   You will receive another notice of the new due date before any changes will be made to your coverage.   You do not need to take any action at this time.  

Also, because of a new federal law, no person who currently has Medicaid coverage will lose their coverage during this emergency.  If you are enrolled in Medicaid and get a notice from New York State of Health telling you that your coverage will end after March 18, 2020, you can disregard this notice.  You will have no gap in coverage.  If you have Medicaid you do not need to report any changes to your account except a permanent address change.

If you need assistance applying for coverage or have a question about your individual marketplace account, press “1”

If you are an in person assister, which includes navigators, brokers, certified application counselors and health plan facilitated enrollers, press “2”.

All other callers, or callers that have pressed one, please continue to go fuck yourself.  After only a few hours on the phone today you will have the opportunity to have a quasi-judicial arbitration of the decision against you that will be decided (probably in your favor) within three or four months [2], possibly more because of the unprecedented public health crisis that is quickly killing thousands .  Please continue to hold.

The next few hours were spent making a lengthy telephone log for Healthfirst, including my recorded, at times learned, lectures on the routine mistreatment of low-income healthcare customers, the incentives for corporations to cull the rolls of people like me, 63, low-income, “takers” who force the insurance company to spend way more than they take in from my premiums.  I described the abolition of the Department of Insurance and the Commissioner of Insurance position back in 2011, when NYS was an early adopter of Obamacare.  I compared the decision to merge oversight of health insurance with regulation of all financial services in New York State to the Supreme Court’s cynical conclusion that since we had a half-black president we were now “post-racial” and since racism is dead there is no need for federal enforcement of the Voting Rights Act Martin Luther King had fought for.   I brought in Justice Tawney’s “no rights that a white person is bound to respect” in the context of the rights of low-income patients protected under secret laws that nobody is entitled to see.  

I described the troll bureaucrat at the NYS Department of Financial Services, the man assigned to locate and send me the citation to the law that had overturned Healthfirst’s illegal termination of my insurance.   He wrote to tell me I had my insurance back so what is my problem?  Why do I even need to know the law Healthfirst had allegedly violated when allegedly illegally terminating my insurance?   He’d research the law I’d asked about when he got the time, but I needed to be patient, it had only been two months– AND WE’RE IN THE MIDDLE OF A PANDEMIC.  No response to my letters to Healthfirst CEO Pat Wang or the office of the NYS Attorney General.

Eventually a sympathetic Healthfirst supervisor named Monique, who I spoke to for perhaps an hour, put me through to “Legal”.   This department, presumably, would at least be able to tell me the law they had reconsidered in reversing the “mistaken” termination of my insurance in January.   By the time Monique patched my call through, of course, their office was closed.  I heard a message about making a request for your records, with an email address I very much wanted to have, but I was too slow to jot it down.   I was told to leave a message and they would call me back.  I have been told numerous lies by Healthfirst in recent weeks, so I am a bit skeptical about this promise being kept, but I left what I hope was a relatively calm-sounding message.  

“They will definitely call you back,” said the optimistic rep I called next, to ask for the direct line to the law department.  Of course, he didn’t have it, or the email contact for them, but he assured me that if you leave them a message they “have to call you back.”   I smiled a bitter smile he could probably hear over the phone, took a breath and told him my recent history with untrue promises from Healthfirst.  I didn’t bother to quote the Arbeit Macht Frei [3] lines from the end of the absurdist word salad I’d received last month from Healthfirst:

Healthfirst takes grievances seriously and wants to assure you that all issues are thoroughly investigated.  Healthfirst sincerely apologizes for the miscommunication and any inconveniences it may have caused you. Our mission is to provide Healthfirst members with high-quality health care. Your satisfaction and well-being is our number one priority.

My best guess as to why an agency all NYS consumers who buy Obamacare health insurance are forced to deal with only once a year at renewal time for everybody, in the hectic days between Thanksgiving and Christmas, would intervene in March to summarily cancel a valid insurance contract between a consumer and a private corporation (making a sham of our vaunted “free market” where business contracts are sacred) is the standard functioning of bureaucracy.

Perhaps when Healthfirst told me they’d cancelled my insurance back in January, before apologizing a few days later for their “mistake”, somebody at Healthfirst — during the two or three business days this mistaken cancellation was in effect — conveyed this erroneous cancellation, as mandated by law,  to The New York State of Health.   True to form, this crack outfit got right on it, irrevocably and without explanation (or notice to the insured) canceling my insurance two months later.

A paranoid thought enters my head in the absence of a rational, or even irrational, explanation:  I’m being retaliated against.   Who is retaliating?  

Perhaps the director of the overwhelmed New York State of Health, a politically adroit woman named Donna Frescatore, a political appointee who has been running the New York State of Health Marketplace since its inception, a public servant to whom I have been unkind, here and in numerous emails, when critiquing her opaque, cumbersome, asshole mechanisms for administering healthcare justice, or correcting the many mistakes made by her overworked, undertrained staff.  

When I asked for her name years ago I was told that it was NYSOH policy not to allow reps to divulge her name or contact information, they’d all been read the order.  Admittedly, they admitted, NYSOH is not a private corporation where such secrecy is routinely guarded, it’s a state agency, a public agency, but still, they had their orders.  At the time public servant Ms. Frescatore, now also in charge of Medicaid in NYS, was difficult to locate.  Not anymore.   Here she is, first google hit:

NY State of Health continues to meet the strong demand for comprehensive, affordable health insurance coverage,” said NY State of Health Executive Director, Donna Frescatore.   Feb 20, 2020

It probably didn’t help matters that I included a few snide, angry, intemperate couplets like this one, toward the close of  my second letter to the CEO of Healthfirst:

A corporate “person” is an appetitive psychopath, without conscience or remorse, driven to devour and only constrained by the rare regulation in place to restrain the gnawing impulse to maximize profits, a corporation’s only legal imperative.  

Of course, this kind of viciously overwrought snideness, defensible or not,  is understandably infuriating and never yields a good result.   Who am I to express such unrestrained anger to the head of a corporation that has already had someone call to apologize verbally for accidentally fucking me?  Who am I to demand to know the law under which my arbitrary denial of health insurance was overturned?   

Who knows who eventually read these words, addressed in an electronic supplement to the Department of Financial Services complaint that forced Healthfirst to overturn it’s final determination that I’d have no health care in 2020 (unless I paid full sticker price for it)?

I am wondering why:

1) there is no notice requirement before a health insurance company can terminate health insurance.  (I had absolutely no notice of the “ten day grace period” they suddenly waived after my DFS complaint)

2) NYSOH Marketplace, sole provider of ACA health plans in NYS, does not inform consumers of the practice of insurance companies abruptly (and “mistakenly”) terminating insurance for failure to pay during a “grace period” nobody is informed of

3) there is no provision in the Patient Protection and Affordable Care Act, or NYS law, that requiress notice of termination policies and fair access to the new NYSDFS complaint process that can force compliance with the law.

Is there someone I can talk to at DFS for more information about these questions?

I was eventually referred to the aforementioned troll.  A few days later I got a letter from the NYSDFS instructing me that since my insurance is a form of pay-as-you-go Medicaid (my income being 167% over the official poverty line) I may not use their handy on-line complaint form, the one that restored my insurance within two business days.  

Because of the low-cost insurance I have, a kind of pay-as-you-go Medicaid created by the ACA, I must wait on line with the rest of the poor people at another state agency, where the newly promoted Donna Frescatore is also deputy director of Medicaid in NY State.   This agency, the New York State Health Department, has no on-line form, or on-line help, or anything else (it’s designed for the poor, after all), but, stay positive and have a nice day, Dude!    

Remember, stress is very bad for your immune system, particularly during a plague!   Please continue to hold, just pretend your life doesn’t depend on it!  

LOL.

 

 

[1]  When the law protecting  low-income patients is designed by the conservative Heritage Foundation, whose mission is to protect the profits of private enterprise, you get more deaths during a health emergency than would generally be considered acceptable in a civilized nation.   The business of America, after all, is business.

[2]  One year I was denied health insurance for three months while I waited for a determination from a NY State of Health arbitrator that the NY State of Health had mistakenly denied me coverage.   Another year it was about six months before the premium subsidy I was entitled to was applied, retroactively, to my account, which I’d been paying full price for pending the decision in my favor.  

[3]   The German words meaning “Work Liberates” were worked in wrought iron on top of the gates to the infamous Nazi death camp where slave laborers for German industry (including Bayer) were worked to death.

 

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