American Healthcare under the unamended, serially challenged ACA

I got a notice on Sunday from the New York State of Health, the state entity that administers the Affordable Care Act Marketplace in NYS, selling various plans and being the final arbiter of all things health insurance for millions of otherwise uninsured New Yorkers. It has been run, since its inception, by a marginally competent and apparently energetic Cuomo appointee named Donna Frescatore. Under her stewardship, you can get the New York State of Health to fix their own errors (if they result in denial of coverage or denial of the subsidy the law says your income provides for) only after arbitration, a process that takes just three months or so. I’ve had to do this twice over the years (while having no health insurance the second time). Fair is fair. Frescatore has been promoted for her excellent work at the NYS of Health and now also runs New York State Medicaid, because, why not? Albany is known as a corrupt town and Cuomo is suddenly looking every bit as obnoxious and autocratic as many of us long felt he is.

Anyway, because the New York State of Health gave me no notice last March that I needed to upload a document I’d forgotten to maintain my insurance coverage (though they sent a timely notice to my insurance company, informing them to cancel my insurance effective April 1) I found myself without affordable health care during the first full month of the pandemic’s initial surge in New York City, where I live.

I found out when a doctor’s office called me to tell me there was a problem with my upcoming visit, my insurance had been rejected. In disbelief, since I’d paid premiums for the entire year, I contacted my insurance company and learned it was true. This time, they informed me with regret, NYS had cancelled it. The insurance company apparently has no legal obligation to pass on such notice to the consumer under the PPACA. So sorry!

Infuriating, yes, scary too, particularly during a massive public health emergency that has now killed about 525, 000 Americans. Fortunately for me, I didn’t need to seek arbitration last April, and since I learned my insurance had been cancelled a few days before the deadline for getting it back in May, I was able to complete the ten minute on-line fix before the April 15 deadline for coverage in May. A friend advised me to go the the NY State of Health website and see why I’d be terminated. I uploaded the document they’d requested, the whole thing took a few minutes. If I’d had notice (NYS of Health claimed, falsely, that I had) I would have done this the day my insurance company was ordered by NYS of Health to cancel my insurance in 20 days. Last year my insurance was restored effective May 1. Slight harm, slight foul. I was glad to have health insurance again during lockdown.

When I went to renew my plan for 2021, in the weeks between Thanksgiving and Christmas, when all New Yorkers are required to re-enroll, I was surprised to learn that my renewal was not due until May 1, 2021 (or April 15th, I guess). I verified this, paid my first six months’ premiums and have had no problem with services under my insurance since.

I’ve often questioned why the overwhelmed NYS of Health makes everyone re-certify in these hectic weeks at the end of the year, when phone lines are jammed, mistakes are routinely made, the website crashes, instead of on a rolling basis, say, by birthdate which would allow everyone to be better served. One characteristic of a great, unaccountable bureaucrat is inviolable rigidity.

I had a notice from NY State of Health on Sunday night, in their typical opaque bureaurcratese it notified me:

I suspected it had to do with my obligation to re-certify before the fifteenth of the month prior to the first month of coverage, on pain of losing health insurance with likely arbitration looming if I wanted help paying for ongoing health care. The arbitration is great, by the way, after only a month or two wait, you get a formal hearing over the phone, where a lawyer/arbitrator grills you and you present your side of the story complete with all evidence you may want to submit. A few weeks later you receive an arbitrator’s decision in the mail. I’m two for two in these, although, in fairness to everyone, I practiced law for fifteen years or so.

I keep thinking of the tens of thousands of poor bastards who lose insurance or premium subsidies every year who may not be up to putting on a legal showing of NYS of Health’s errors resulted in their loss of affordable health care. An experienced lawyer who doggedly searched the law for months, calling every state and federal (and NYC) office I could fine, spending hours on-line, I never found the law my insurance company had violated when they’d illegally terminated my insurance the previous (and instantly restored it when I filed an on-line complaint at the NYS Department of Finance– of course it was DOF!). I think, what chance does the average low-income New Yorker stand against the opaque Patient Protection Act?

Typical of all fucking notices from the NY State of Health, they bury the lede, (after informing the reader in the annual notice of notice email that the customer may have received the message in error). The notice is usually many pages long, and what you need to do is often set out on page eight or ten, like they want to make sure to fuck your brain good and proper before coming to the point, informing you of your inviolable obligation. Of course, this could be succinctly stated at the top of the notice, but… what the hey? I assume Donna Frescatore (who does not allow her subordinates at NYS of Health to give out her name) has something to do with this oppressive approach to informing low-income citizens of their rights and obligations. What you need to do to keep your health insurance could be up top, on page one of the important notice, but, you know, fuck it.

Much as I despise her type, Donna probably had nothing to do with this next bit, which is surely part of the Patient Protection Act itself (the communist inspired one passed on a party-line vote by the last illegitimate president before the present illegitimate one, inserted after massive, obvious but unprovable fraud — the very worst, most insidious kind of fraud!!):

IMPORTANT: When you end coverage with one plan and start a new one in the same year, all
of your cost-sharing responsibilities start over. For example, any payments that went toward the
annual deductible for your old plan will not apply to the new plan. This is true even if the new
plan is with the same company.

Which only stands to reason, you know, because, why not? Corporations are people too.

I remind all Americans that this shit is an exclusively American sickness– advertising medications — “ask your doetor!”, excluding eyes and teeth from the definition of “health care”, buying health insurance rather than health care itself, a trillion dollar industry with a million wealthy middle men demanding Americans pay way more for health care than citizens of any other civilized, wealthy nation in the world. Every “moderate” Democrat in Congress will defend each of these self-evident things as right, just as ordained by Jesus Christ Himself.

Medicare, the popular health insurance program for Americans over 65, had many problems when it was first passed under LBJ. Those problems were addressed and many were fixed over the next few years. In contrast, the ACA, a highly conservative plan (brainchild of the Heritage Foundation — deniers of climate science, promoters of the myth of voter fraud and so forth) that left the profits of large health corporations intact, has been attacked by angry Republicans since its passage, many attempts to repeal it launched (recall, it was only the dying John McCain’s dramatic thumbs down that saved it under Trumpie) and so all of its original warts and infirmities remain. When it works, it’s fine. When you hit any kind of snag, you’re pretty much fucked, patient protections or no.

Now I’m going to go back to read the rest of the fucking thing, the informative and entirely reasonable gem above was on page three or four.

Whew, further down the notice we learn:

Please Note: Changing your coverage is different than ending your coverage. If you want to switch
plans and do not want to make any other changes to your account, call NY State of Health to find out if
you are eligible to switch plans and to pick a different plan. Enrollment in Child Health Plus and the
Essential Plan can be changed at any time during the year.

I just read all seven pages of this important notice (that may have been sent to me in error), doesn’t seem to be any action I need to take at this time. Here are just some of the other languages one can request this important document in:

Getting Help in a Language Other than English

This is an important document. If you need help to understand it, please call 1-855-355-5777. We can
give you an interpreter for free in the language you speak.

Español (Spanish)
Este es un documento importante. Si necesita ayuda para entenderlo, llame al 1-855-355-5777. Podemos proporcionarle gratuitamente un intérprete en el idioma que habla.

繁體中文 (Traditional Chinese)
這是一份重要文件。如果您在理解這份文件上需要幫助,請撥打電話:1-855-355-5777。 我們可為您免費
提供一名會講您的語言的口譯人員。


简体中文 (Simplified Chinese)
这是一份重要文件。如果您在理解这份文件上需要帮助,请拨打电话:1-855-355-5777。 我们可为您免费
提供一名会讲您的语言的口译人员。


Русский (Russian)
Это важный документ. Если вам нужна помощь, чтобы понять его, позвоните по телефону
1-855-355-5777. Мы можем бесплатно предоставить вам переводчика на ваш родной язык.

Kreyòl Ayisyen (Haitian Creole)
Sa a se yon dokiman enpòtan. Si ou bezwen èd pou w konprann li, tanpri rele 1-855-355-5777. Nou ka
ba ou yon entèprèt gratis nan lang ou pale a.

বাংলা (Bengali)
এ􀎜ট এক􀎜ট গুরুত্বপূণ ন􀎺িথ। যিদ এ􀎜ট বুঝেত আপনার সাহােয􀒝র প্রেয়াজন হয় তেব অনুগ্রহ কের 1-855-355-5777
এ কল করুন। আপিন􀎭য ভাষায় কথা বেলন আমরা আপনােক িবনামূেল􀒝􀎭স ভাষায়􀎭দাভাষী প্রদান করেত পাির।

اللغة العربية (Arabic(
هذه الوثيقة مهمة. وإذا كنت بحاجة إلى مساعدة لفهم الوثيقة، يُرجى الاتصال على الرقم 5777-355-855-1 .ويمكننا أن
نوفر لك مترجمًا فوريًا باللغة التي تتحدثها مجانًا.

한국어 (Korean)
중요 문서입니다. 이해하는 데 도움이 필요하시면, 1-855-355-5777번으로 전화하십시오. 귀하가 사용하는
언어의 무료 통역사를 제공해드릴 수 있습니다.

Français (French)
Ceci est un document important. Si vous avez besoin d’aide pour le comprendre, appelez le
1-855-355-5777. Nous pouvons vous offrir gratuitement les services d’un interprète qui parle votre
langue.


Polski (Polish)
Ten dokument jest ważny. Jeśli potrzebuje Pan(i) pomocy w jego zrozumieniu, proszę zadzwonić pod
numer 1-855-355-5777. Możemy zapewnić bezpłatne usługi tłumacza w Pana(i) języku.

􁤖हन्दी (Hindi)
यह एक महत्वपूण􁭅दस्तावेज ह।ै य􁳰द आपको इसेसमझनेकेिलए सहायता क􁳱आवश्यकता हो, तो कृपया 1-855-355-5777 पर
कॉल कर􁱶। हम आपको आप जो भाषा (􁳲हदी) बोलतेह􁱹उसम􁱶िनःशुल्क दभु ािषया सेवा प्रदान कर सकतेह।􁱹

اردو (Urdu(
یہ اہم دستاویز ہے۔ اگر آپ کو اسے سمجھنے میں مدد درکار ہے، تو براہِ کرم 5777-355-855-1پر کال کریں۔ ہم آپ کو
آپ کی زبان میں مُفت ترجمان فراہم کر سکتے ہیں

And I think to myself, what a wonderful world! It really is amazing how varied and adaptable we brilliant (and sometimes irrational and brutal) wise apes are. Can you say that in Urdu?

Two small puzzlers

How has the court not thrown out Georgia governor Brian Kemp’s strategically political lawsuit trying to stop Atlanta mayor Keisha Lance Bottoms from mandating mask wearing in public during the pandemic? 

Kemp brought the emergency lawsuit to enforce his arguably rational executive order, which reads in part:

“Any state, county, or municipal law, order, ordinance, rule, or regulation that requires persons to wear face coverings, masks, or shields, or any other Personal Protective Equipment while in places of public accommodation or public property are suspended to the extent that they are more restrictive than this Executive Order.”

How is it that the court didn’t throw out this nakedly political lawsuit, selectively brought against a black, female Democratic mayor, when Kemp did not sue the mayors of Georgia cities “such as Savannah, Athens, East Point, College Park, and Brookhaven” who also issued mask mandates?

Oh, I see.   Hadn’t heard that one.

And this laundry list of  Orwellian horse shit about how Mr. T (who is pursuing a case in the Supreme Court to abolish the Affordable Care Act during a pandemic) is reversing Obama’s vicious health reform law to benefit all American suckers (could she be describing the campaign promise he made in 2016 to give all Americans cheaper, better health care?):

And this beauty for seniors, the vulnerable old bastards (I’m 64, yo) who Mr. Trump is doing everything possible to prevent from voting by mail during a pandemic that disproportionately kills us (and this demographic overwhelming supported Mr. T in 2016– SAD!) :

It’s all being done in good clean fun, folks!   

Seriously, can’t y’all take a joke?   ROTFLMAO!

 

Bonus — Billionaires for Trump:

#10 Kelcy & Amy Warren

Net worth: $2.5 billion
Source of wealth: Pipelines
Contributions: $721,200
Gave to 2016 Trump campaign? Yes, $100,000

Kelcy Warren cofounded pipeline company Energy Transfer with Ray C. Davis (now also a billionaire) in 1995. Warren’s fortune stems from publicly traded company Energy Transfer LP, of which he is CEO and chairman. In 2017, following protests, Energy Transfer finished building the $3.8 billion Dakota Access Pipeline after an executive order from President Trump. Energy Transfer says the 1,172-mile pipeline can transport almost 500,000 barrels of oil daily.

source

American Exceptionalism (pandemic version)

When it comes to glittering generalities pulled out of a wordsmith’s talented ass, grand-sounding but largely meaningless, American Exceptionalism is no exception. What it actually means … well, it’s similar to The Free Market, Manifest Destiny or Making the World Safe for Democracy.   I offer a humble example here, of how profit-driven private industry is the most exceptional possible answer to American health care needs [1].  

I went to a lab for a blood test today, in preparation for next week’s telephone appointment with a nephrologist to find out if my rare kidney disease is still in remission, as it was seven or eight months ago, when we last checked.   I was supposed to have checked in with the doctor last month, but as I found out on the eve of the visit, I had no health insurance, though I’d paid my premiums through June.  Nobody had bothered to inform me that my health coverage had been summarily cancelled a few weeks earlier.  Oh, well.  Apparently no law requires it.

No worries, problem fixed, a few short weeks later I have my affordable health insurance back.  I call the lab yesterday to make sure they have the digital paperwork, but because of COVID-19 nobody at the lab can pick up the phone to confirm this.   No appointment needed, come on in, short waiting times, says the recording.   So I take a ride over today.   Pleasant place, everyone very nice, short wait, plenty of hand sanitizer available, they call me in and ask for my paperwork.  

I explain that it was digitally transmitted, on April 10, according to a note on my phone.  The lab has no paperwork on the computer for me.   Perhaps there was a paper file faxed over?  I am asked.    They open the file cabinet, check the hanging folders of paper files.  Nada.   Can I have them fax over the paperwork?   I call the hospital where the nephrologist’s office is, navigate the phone tree, get connected to the person I need to speak with.

Carmen at the nephrologist’s assures me they uploaded the document on April 10, it’s in the lab’s database, she’s looking right at it on her computer.   I give her the fax number and she tells me she’ll fax it right away.    No fax arrives.  I call Carmen again and she informs me the lab’s fax machine is not receiving faxes.  She reads me a requisition number 0062216, this should allow them to pull it right up on the network.  Only it doesn’t, as I find out a few moments later.  

Crystal, a lovely phlebotomist with whom I am starting to become friendly by now, asks me to spell my name.  I do.  She is surprised.   Somehow they had my name as a long, hard to pronounce one, starting with a P, not a W, something like Pidelszkfflmm.  Crystal asks if I could have typed it in wrong when I signed in on the iPad.

I look at the keyboard on my phone and notice that P is all the way on the other side of the keyboard from W, the first letter of my last name.   Not likely I typed in my own name as Pidelszkfflmm, I’ve typed my name many times, never anything like that.  Never mind.   There must be some work-around.   Yes, Crystal says brightly, I can ask them to email it to me, go home, print it out, bring back the paper copy. When I explain the many extra steps involved for me, and how I want to leave time for the results to come back, and remind her I’m still fasting and ready to have my blood drawn, Crystal gives me her email address.  I call Carmen a third time, we repeat the email address to each other a few times, she tells me she’s emailing it, she waits with me on the line until the email arrives.

“You got any jokes?” I ask Carmen after a while.  She finds this funny, but can’t think of one.  

“I watch the news conferences every evening,” she says, and we do a kind of sickly pseudo-laugh together.  

Crystal gets the email from Carmen,  she does the blood test, all very pleasant, all within an hour or so of walking in to the place.   I am ready to leave, take off my N95 mask, find some food, break my fast.

“I hope you didn’t just use the bathroom,” Crystal says to me after my blood is drawn.  I’m thinking of COVID, but it’s not that, she also needs some urine to send to the lab.  I shake my head, three minutes ago I could have filled up two of those little cups, but…

While I’m waiting for a tall cup of cold water to do its thing, thinking about Crystal’s warning to me that the PSA test (prostate-specific antigen — a screen for prostate cancer)  included in the kidney doctor’s blood test might not be covered and I may be billed separately (I assure her I throw such bills in the recycling bin) I ask her if she knew that in Iraq, under the brutal dictator Saddam Hussein, Iraqis had universal health care.    She is non-committal.  I continue: after the US liberated Iraq from the dictator and brought democracy, after destroying hospitals and so on, they instituted American-style health care, with the result that today many Iraqis no longer have health care at all.  

Crystal nods. “Of course, of course we did that, ” she says, her eyes smiling savagely over her mask, “American Exceptionalism.”  I give a little chuckle, have to hand it to her.  Great girl, and the way she slipped the needle in, with barely a prick, also most exceptional.   We talk about how it is exceptionally American that teeth, vision and care in our old age are not considered part of basic health care, not covered by most American health insurance.  I nip off to the bathroom for a moment with the little plastic cup.   She calls me Mr. Eliot again as I hand her the little cup of warm urine.   As I’m leaving, her last customer of the day, she fondly calls me Mr. Eliot again.   Very likable young woman, Crystal.

If you have a “Free Market” where the fittest bring the best product to market for the cheapest price for the invisible hand of the marketplace to place in front of wise consumers, why wouldn’t you commoditize every aspect of human life?   Health, you understand, is just a commodity like everything else.  Life itself, you can actually put a price to it, make a pretty exact valuation based on net-worth and earning potential, easily calculated by actuaries.   There’s actually no guesswork involved, it’s practically science, fixed and elemental as the stones themselves; that’s the exceptional thing about American Exceptionalism!

 

 

[1]  I think of the Grey Lady, America’s second finest news source (The Onion is America’s finest news source), whose distinctive, objective style of reporting harkens back to an earlier time, when the status quo was not questioned in any fundamental way by decent people.   She fittingly got her nickname in a more proper era when we still had firm notions about what was ladylike and what was gentlemanly, when an unruly girl was admonished to act like a lady.   The Grey Lady, now a stately, dignified, respected old matriarch, was, in her earlier days, a hard-working, discreet and strictly upper-class sex worker.    You can look it up.

 

 

 

Notice to sustain legal termination of benefits for those who rely on a government program for health care

It gets better, the closer you look.  By better I mean, of course, much worse.

Here is the top of the March 11 notice I had absolutely no notice of (until, in desperation, suddenly, irrevocably without health insurance or access to affordable health care, I stumbled on it on April 14):

Screen shot 2020-04-28 at 12.01.26 PM.png

That highly effective, legally impeccable March 11 notice, transmitted immediately to my insurer (my only copy was belatedly found, a month too late, nestled in the inbox of the website we are forced to visit once a year to re-enroll,) referred to the “separate notice” I also had, exclusively in my inbox on their website, the one placed in my inbox the day after I re-enrolled last December.  

Emails from your agency, your corporation, reminding us about voluntary customer surveys untaken, updating us about your handy new phone app?  Sure, absolutely, we can send as many of those as you like.  A single email informing you your health insurance is in immediate jeopardy of sudden cancellation without notice?   Show us the law that requires that, loser!

An unambiguous warning, you must admit, that March 11 notice.  If I’d seen it, I would have known what I needed to do immediately (as I quickly and easily did on April 14, as soon as I found the March 11 notice on-line).  Unfortunately, the law doesn’t protect LOSERS from their own negligent mistakes, loser!  What’s hard to understand about read the fine print CAREFULLY?

There was, admittedly, a strong hint in December’s “separate notice” informing me that, although I had apparently successfully re-enrolled for 2020, and would be covered for a long period, that I was not yet actually fully qualified for the insurance that had been approved (and that covered me from Jan.1 through March 31, and from May 1 til the end of the year, presumably).  

That much was  made plain in the very first lines of the 12/7/19 letter, the “separate notice” noticed in the notice of March 11.  In hindsight, the clues “for a limited time” and “required document(s)” are dead giveaways. How could I have been so dang STOOOO-pit?!

The 12/7 notice begins:

We have redetermined your household’s eligibility on December 6, 2019 for enrollment through NY State of Health based on updated information we recently received.  Below are the results of our determination: EW Marketplace ID: HX000075019789123123345677889

Eligibility Result: Eligible to enroll in the Essential Plan with a $(redacted) premium per month for a limited time. This means that you must return required document(s) to NY State of Health to continue your eligibility. The Essential Plan will cover all essential health benefits with low co-pays for certain services and no annual deductible. You may choose to also enroll in dental and vision benefits for an additional monthly premium. This eligibility is effective as of January 1, 2020.

What you need to do next: Provide additional information in order to confirm your eligibility – More information about what documents you need to provide NY State of Health can be found in the “Request for Additional Information to Confirm Your Eligibility” section of this letter.

Using your health coverage – You will receive services through your health plan. Information about your benefits can be found in the “Additional Plan Enrollment Information for Essential Plan” section of this letter.

In fairness, the “Request for Additional Information to Confirm Your Eligibility” section plainly described the  document I needed to submit.  It was right there, in impossible to miss black and white, on a long list on page 12 of the twelve page letter.   It is likely the drop-dead cancellation date of March 5 (triggering the March 11 notice to insurer to cancel effective March 31) was also explicitly mentioned somewhere in the bulk of the letter, perhaps after the several pages that repeated certain legal rights in a host of languages spoken by the citizens of New York State (which is where the tax document I uploaded was listed).

The point, of course, is not whether any of it is fair or not.  The point is not whether somebody with the means would hire a lawyer and take legal action to have something done about this kind of outrageous institutional abuse.  A person of means would not find themselves in this position anyway, there are certain minimal protections for the average prosperous citizen, even as they may not be robust protections (except for the extremely wealthy).    The point is:  if you depend on the kindness of your government and the corporations it does business with TO HELP YOU, what are you going to fucking do about it, you fucking loser?  LOOO-zuh!

Go write a sarcastic tweet, as is your absolute privilege under the United States Constitution, Amendment One.

No Intent Can Be Implied– though, to be honest, the intent is pretty clear

We are sometimes reminded, often by lawyers for people doing bad things, that we cannot infer legal intent from a mere course of conduct, no matter how consistent or seemingly suggestive.   This lawyerly principle applies even when that intent is expressed in a clear, polite, unambiguous “fuck you, asshole.”  

I’ve had my health insurance cancelled without warning twice since January 2020; luckily for me I found out about it the second time (cancelled without notice March 31) just in time to have my low-cost insurance back, as of May 1.  Nobody is to blame for any of this except, presumably, me, though intent on my part remains unclear.  

In January, when I called to pay my insurance premium for the ACA health coverage I’ve had for several years, the insurer told me I’d missed a ten-day “grace period” they’d had no obligation to inform me of and that my insurance had been irrevocably cancelled, pursuant to the “guidelines” (whatever those might be).   Two days later Healthirst, the insurer, confirmed that I’d lost an internal appeal and that my insurance had been properly terminated.

Meanwhile, I found an on-line consumer complaint form at the New York State Department of Financial Services, the agency responsible, among other diverse duties, for regulating health insurance companies that do business in the state.   Within two business days of submitting this complaint I had a call from Healthfirst, apologizing for its mistake and restoring my health insurance.

I was naturally curious about what law or regulation had caused them to reconsider their irrevocable, unappealable, legal decision.  They could not tell me. I want to know this law.  I’d like to publicize it to the many agencies I’d spoken to, government agencies who had no idea what the patient protection law in New York State requires of insurers before they can terminate ACA insurance without notice. Hearing nothing back from the Department of Financial Services, after my complaint quickly resolved my sudden lack of insurance,  I wrote them this:

I had a call from Healthfirst on January 28 informing me that their termination of my insurance had been a “mistake” and that they were sorry.  They admitted they had received my 1/24 NYSDFS complaint and were ready to accept the payment for January-June 2020 I’d attempted to make on January 22 when they informed me that I had no health insurance and that there was no further appeal at Healthfirst, or anywhere else.

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 findable provision in the Patient Protection and Affordable Care Act, or NYS law, that sets out notice required before terminating policies.  

Is there no provision requiring private health insurance companies to direct suddenly insurance-free patients to the new NYSDFS on-line complaint process that can force immediate compliance with the unknowable law?

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

Two weeks later, on Valentine’s Day, in fact, I had a response from DFS [1], a form letter, addressed to me, instructing me that DFS has no jurisdiction over my low-income healthcare and that all future correspondence should be addressed to the overwhelmed NYS Department of Health, the agency that oversees all Medicaid and Medicaid-like health plans for low-income New Yorkers.   The NYS Department of Health, perhaps because its programs serve primarily poor people with no other options, has no analogous on-line process for quickly resolving violations of undiscoverable laws.

My individual story had a quick reversal of fortune, a lucky, happy ending.   I did not lose my insurance for more than a few days, and it had been retroactively restored with alarming speed.   That was the position of the attorney at DFS who was assigned to provide me a copy of the law that had caused Healthfirst to reconsider its unappealable termination of my insurance.   He e-mailed me that since the insurer had admitted its error and restored my insurance that I should no longer need to see the provision of the law that had forced them to do so.

I periodically wrote to this lawyer for status updates, since he’d been assigned to provide me the relevant legal provisions I’d requested.   He asked me again, only six weeks in, to be patient, and questioned my stubborn-seeming need to know the law, since my insurance had been restored.  He also disputed my assumption that I’d not been alone in having my low-cost insurance abruptly terminated.  

He didn’t necessarily agree that a private company, with every incentive to cull non-profitable low-income insured from its rolls, and no disincentive, outside of being forced to admit error, if one of the poor devils stumbled on a legal remedy at the agency that regulates them; none of that meant that private insurance corporations would necessarily take advantage of unsophisticated or language-challenged low-income customers it was forced to insure by the opaque 906 page Patient Protection and Affordable Care Act.

It became a kind of hobby of mine, trying to remain polite to this government attorney, who seemed to be a kind of troll, judging by his terse non-responsive responses.   I was probably being unfair to the man.  He was probably right; I should have simply been grateful instead of a persistent burden to this hardworking government lawyer.

All was well, until, suddenly, in the midst of the worldwide pandemic, where I found myself at its epicenter, a doctor’s office I had an upcoming kidney disease-related appointment with (by phone) informed me that my insurance came up “inactive”.  I told them that was a mistake, my premiums were paid through June.  They told me I’d have to straighten this out with my insurer.   

It could not be straightened out with my insurer, who informed me that unfortunately there was nothing they could do — they were following orders from a New York State agency that they were forbidden, by law, to contact on my behalf.   I was told on that April 10 call that the insurer had been informed, electronically on March 11, to cancel my insurance effective March 31.   I’d had no such notice. Nobody, apparently, had any legal duty to inform me that I was about to lose my insurance or even that I was now uninsured.  During a pandemic.

I did not react well to this news.   In spite of the personalized February 14 warning that I was not entitled to use the DFS on-line complaint form (a warning not made anywhere on-line when you go to complain) I immediately submitted this:

I was informed Friday afternoon, when I called my insurer after being told by a doctor that my insurance came up “inactive,” that my Healthfirst health insurance, prepaid through June, had been cancelled, effective March 31 by the New York State of Health Marketplace.  

According to Healthfirst, no reason for this termination was given by NYSOH, NYSOH, I was told, had sent Healthfirst notice of their intent to terminate my ACA insurance on March 11.  Neither Healthfirst nor NYSOH provided me any notice of this termination, not prior to the effective date nor since.

I am instructed to call NYSOH, an overwhelmed and unresponsive agency on a good day, where one hears this recording:

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.

I have to assume that termination of prepaid health insurance without notice violates some NYS law, administrative rule or something, in addition to the due process protection of the US Constitution and the PPACA.  One searches for New York’s legal answer to this question in Titles 10 (Health) and 11 (Insurance) of the NYCRR  in vain, there is no chapter on point.  

Can you help me get my improperly terminated insurance back during this worldwide plague? I’d be eternally grateful.

 

Thankfully, before they had time to act on this complaint, a friend helped me discover a copy of the March 11 “notice” from the NYSOH, on their website, in my inbox.  I’d received no email informing me of its existence on the website low-income New Yorkers are required to visit annually to re-enroll, not that day (when I could have acted to save my insurance for April), not any day.   I also did not receive a copy of this notice by mail, not in March, not on any day.   When my friend asked if I’d checked the website, and my “inbox”, I went on-line, saw the “notice” for the first time, fixed the omission in my application, re-enrolled and was quickly good to go effective only a few weeks later, on May 1.

I attempted twice to retract my DFS complaint, on April 14 and April 15.  I wrote:

I withdraw complaint CSB-2020-01351366.  Healthfirst had nothing to do with this termination of my ACA health insurance. They might have informed me of the impending loss of my insurance, which they knew of for three weeks before it was terminated, although they likely had no legal duty to do so and every business reason not to.  My complaint should not go to Healthfirst.

My insurance was terminated by the NYSOH, for my own oversight,which remained uncorrected for lack of notice of the mistake by NYSOH.  I have since been able to correct this oversight and my insurance will be restored effective 5/1/20.  

Please terminate this complaint. 

I was too late, though, the wheels of justice were already grinding on my behalf. The very next day I had a call from the same Resolution Specialist at Healthfirst who’d resolved nothing previously, informing me in grim tones that they had received the DFS complaint, that she was calling pursuant to it and so forth.   My description of that unexpectedly pleasant chat is here.

Here’s the thing, though.   Within a couple of days, on April 17, I had an email from DFS with two attachments.  The first attachment was the same form letter I’d received previously, directing me, as a low-income New Yorker, to the Department of Health, informing me, again, that, although they’d once again quickly investigated my complaint, DFS was not the proper agency to contact, since I was too poor to qualify for their on-line consumer services.  

The second attached PDF was an official summary of legal findings  — something we must note was not prepared or sent to me in the previous case, when the insurer had, and later admitted, erroneously terminated my health insurance in January.  

Again, no inference of intent is drawn, why should it be?   Can an agency or a corporation even have intent?   The report of their legal findings was dated April 16, 2020, the day after my second attempt to retract my complaint.

Curiously, on the cover sheet of this three page report, next to the box “Has the member been made whole?” the answer DFS inputted was NO.

I have transcribed it from the PDF faithfully (outside of a few added comments):

This communication serves as the Plan’s Response to the Member EW (sic), grievance against the Plan regarding his termination of coverage on 03/31/2020.  We have researched the member’s grievances and provided below is a summary of our findings and resolution.  

Upon receipt of the complaint the Enrollment and Billing Departments advised:  

* The Member EW enrolled into Healthfirst Essential Plan with an effective date of coverage for 01/01/20.   The Member’s coverage was active and paid through March 31, 2020 (paid through June 30, actually, but why quibble?).  

* On 04/15/20 the Enrollment and Billing Department advised (who?) that the Member’s coverage was terminated as per the New York State of Health transaction file no. ET00158341700 received on March 11th, 2020.   (Note, 4/15 was days after I complained of this conversation, which took place April 10)

* An inquiry was sent to the New York State of Health regarding the Member’s coverage termination.

The Plan advised (was advised?) that on:  

*On 12/07/2019, the New York State of Health sent a letter requesting proof of income that needed to be submitted by 03/05/20, in order to maintain continued coverage.  (why March 5, a deadline both arbitrary and capricious?)

* On 03/11/2020, the New York State of Health sent another letter indicating that proof of income was not received as requested, and that Member’s coverage will be terminated effective 03/31/2020.     (really)

* On 4/14/2020, the Member uploaded the required documents and was re-enrolled for an effective date of coverage 05/01/2020.  

* On 04/16/2020, the Member Services Department outreached the  Member regarding his complaint.   The Member informed the Plan that he realized that the termination was not Healthfirst’s decision, but on the part of the New York State of Health.   The Member advised that he tried to rescind the complaint but realized it was too late (he did when he got the call from insurer– for sure — ed.).  The Member verified that as per New York State of Health that his coverage would begin 05/01/20. A credit is currently on file and will be applied to the Member (sic) future coverage (applied to July’s premium, actually).  

We trust that this response provides sufficient explanation for your inquiry.

The official report was signed by a female employee of DFS, to whom I can only say, (with Joe Biden-like insouciance), it could all not have been clearer, sweetheart.

 

 

[1]

Screen shot 2020-04-28 at 2.46.39 PM.png

 

retracting DFS complaint number CSB-2020-01351366

As I emailed the New York State Department of Financial Services earlier today:
I have been unable (last night and so far today) to log into the DFS portal where I submitted this complaint yesterday.   I was told to email your agency here.
I withdraw complaint CSB-2020-01351366.  Healthfirst had nothing to do with this termination of my ACA health insurance.   They might have informed me of the impending loss of my insurance, which they knew of for three weeks before it was terminated, although they likely had no legal duty to do so and every business reason not to.   My complaint should not go to Healthfirst.
 
My insurance was terminated by the NYSOH, for my own oversight, which remained uncorrected for lack of effective notice of the mistake by NYSOH.  I have since been able to correct this oversight and my insurance will be restored effective 5/1/20.  
Please terminate this complaint.  

Low-Income Funnies, Pandemic Edition

Because I get my low-cost health insurance through Obamacare, the Patient Protection and Affordable Care Act of 2010 (ACA), I am required to re-enroll every year.  I do this, along with every other low-income New Yorker without employer-based insurance, during the relaxing weeks just before Thanksgiving to just before Christmas.   The ACA is administered in New York State by an overwhelmed agency called the New York State of Health Marketplace.  ACA health coverage is, as we learn, an easy-come easy-go form of health insurance.

The “entitlements” our government generously extends to people of low income are precious, sometimes matters of life or death.   Oddly, such benefits can be instantly clawed back with little or no notice to those who benefit from the programs, if the poor sucker makes a simple but inexcusable mistake.  I used to see this all the time when I represented some of the poorest and most desperate New York City tenants, most of whom I was able to save from homelessness.  

A wheelchair-bound double amputee got a late notice of a “face to face” meeting she was required to attend to keep her housing voucher intact.  She was unable to schedule Access-A-Ride on one day’s notice.  I spent over a year, thirteen times in Brooklyn Housing Court, trying (and in the end succeeding) to restore her housing benefits and prevent her eviction.  The government’s attitude was that this lazy bitch should have found a way to be at that meeting if she wanted continued assistance paying her rent.

So it was for me, years later, that the New York State of Health decided that the fatal December 6 mistake in my 2020 application had gone unaddressed for long enough.  On Good Friday (I’ve had better Fridays) I was informed that my health insurance had been cancelled on March 31, 2020.  I had no notice of the cancellation until I tried to use my insurance again in April.  

From a legal point of view, it is debatable whether I had notice from NYSOH before they terminated my health insurance.   I had the scantest fig leaf of legal notice of my original oversight and what action I needed to take to correct it; two letters in the inbox of New York State of Health’s website, a place otherwise uninsured New Yorkers visit once a year when we are forced to log in to reapply.  

True I had no emails from NYSOH telling me to check the inbox on their website on pain of losing my health insurance during a pandemic (I had several emailed ads for the handy new NYSOH phone app during this time), or any notice by regular mail (as their web-posted letters claimed I’d had) but NYSOH inserted both long, detailed legal warning letters right there in my on-line inbox, on December 7 and March 11, to be used as conclusive proof of notice in the event of a lawsuit by the disgruntled former recipient of government-subsidized health insurance.

I finally learned of my easily fixable mistake, after 74 hours of life-shortening stress and anger, while talking about my legal options with an old friend from law school (an online Article 78 to challenge the arbitrary and capricious cancellation of my insurance without reason given, or notice). Once I discovered it (tip of the hat to you, Jon) it was a matter of about 20 minutes on-line to fix my December 6 omission, re-apply and have my health insurance restored effective May 1, 2020.  [1]

My December 6 omission, by the way, was failing to include proof of income I didn’t receive until several weeks later.  My insurance was, I was informed in the first of these on-line letters I didn’t see, conditional, its continuance beyond March 31 depended on me fixing this mistake before that date, and I simply, willfully, refused to comply with the part of the law I’d forgotten about this time.

If I’d had actual notice of the problem, on the date of their second notice, I could have easily updated my application, fixed the fatal problem in March and avoided any interruption in my health insurance coverage.  

You have to admit, it’s funny as plague-infected shit, in a certain sick and deadly way.  May you and your loved ones never know from such hilarity.   God bless the child that’s got his own and God bless these United Shayyyysssssh.   

 

[1] Fortunately I discovered what I needed to do and re-applied before April 15.  If I’d re-enrolled after the 15th, my insurance would not start until June 1.

Education and Clarity of Language might not help you

Yesterday’s attempt at an Op Ed for the Grey Lady ended with this now deleted paragraph about the seeming impossibility of getting my improperly terminated health insurance back during a raging plague.  Observe the plangent notes of heroic  self-pity:

So I am left to accept my punishment and practice mindfulness.  I sit here lowering my blood pressure, and my heart rate, by thinking of the miracle of communication — how I can sit and convey these deeply fearful things to a stranger, merely by arranging the words properly on a page.  I hope someone will remember I did this when they are lowering my body into a mass grave.   My murdered ancestors would want no less for me.

Admittedly, useless — DELETE! — though I do still greatly appreciate the miracle of written communication, as far as it goes sometimes.  Nothing like writing the situation out clearly when you are in great trouble or danger.

Today I wrote this concise complaint to the NYS Department of Financial Services, the NYS agency that regulates all insurance, financial houses, hedge funds, banks, etc. in New York State,  My latest attempt to take a flying fuck at a rolling donut (though their on-line consumer complaint form immediately fixed a similar insurance termination without notice problem back in January):

I was informed Friday afternoon, when I called my insurer after being told by a doctor that my insurance came up “inactive,” that my Healthfirst health insurance, prepaid through June, had been cancelled, effective March 31 by the New York State of Health Marketplace. According to Healthfirst, no reason for this termination was given by NYSOH.

NYSOH, I was told, had sent Healthfirst notice of their intent to terminate my ACA insurance on March 11.  Neither Healthfirst nor NYSOH provided me any notice of this termination, not prior to the effective date nor since.

I am instructed to call NYSOH, an overwhelmed and unresponsive agency on a good day, where one hears this recording:

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.

I have to assume that termination of prepaid health insurance without notice violates some NYS law, administrative rule or something, in addition to the due process protection of the US Constitution and the PPACA.  One searches for New York’s legal answer to this question in Titles 10 (Health) and 11 (Insurance) of the New York Codes, Rules and Regulations  in vain, there is no chapter on point. 

(I was wisely advised to follow my hunch and delete this line:  I am still waiting (since early February) to hear back from your office for a citation to the text of the controlling law.)

Can you help me get my improperly terminated insurance back during this worldwide plague? I’d be eternally grateful.

Alternatively, can you direct me to the nearest rolling donut?

You Have the Right Not To Be Angry

If you are not wealthy in this country, you have a very limited right to express anger publicly.   Anger, like health care, is a privilege in America, not a right.

A wealthy person who feels aggrieved may hire a team of lawyers to legally bludgeon the person who inflicted the injury.   An angry wealthy person may take out a full-page ad in the newspaper of record, calling for vengeance against someone he hates.   Our current president did this, as a private citizen, when he purchased a full-page of the New York Times to call for the death of five boys locked up for, and eventually exonerated of, a heinous crime.    Anger is all the rage among the rich and powerful.  It is a luxury not permitted to the weak.

I was told in no uncertain terms in January, mistakenly it turns out, that my Affordable Care Act health insurance had been properly terminated without notice, for my failure to do something I had no notice of.   I’d been told by the insurance company that everything I needed to do to have 2020 health coverage had been done.  Then they informed me I had no health insurance because I’d failed to pay a “binder” during a once-a-year ten day grace period that nobody told me about.  The invoice made no mention of a do-or-die grace period.

I had no warning, no chance to fix what they told me was fatally broken in our contract.   This lack of a heads-up struck me as fundamentally unfair, as it probably is, except in a world where superhuman corporate “persons” rule over regular puny earthling persons who proceed at our own peril.

I was angry about this, even after the multiple complaints I submitted resulted in the reversal of this irreversible decision.   Within a very short time I had my insurance restored;  in fact, I had a call from the insurance company apologizing and telling me that my insurance had never actually been terminated.   I rescheduled a canceled cardiologist appointment and had an expensive treatment paid for by the insurance company, at about 30% of the uninsured sticker price, with only my co-pay required from me.

Still, I was irked about the lack of accountability for a health insurance company that had made me suffer agonizing anxiety as I exerted myself mightily to find the hidden legal remedy (hint: NYS Department of Financial Services).  I am pretty sure that the “mistaken” termination had been unlawful, this seems clear by how quickly the final determination against me was changed.  

To my dismay, nobody I spoke to in the city, state or federal bureaucracy could tell me what that violated law was, not its name, its existence, what exact patient protections it contained.  I wanted to see the text of the law, to read the precise patient protections my health insurance provider had ignored, to such unfair and frightening effect.  It is apparently not the right of a powerless citizen to have this kind of information.

I began lashing out in letters and emails, and on the phone.  A Resolution Specialist from Healthfirst called and promised me a written apology and a record of the many calls I’d had with the insurance company, which would allow me to trace exactly what had been done to me and how it had been corrected.   I wanted a roadmap of how the unknowable law had been violated.  I feel a strong need to inform others in my situation of their rights and legal remedies.   None of what I was promised by Healthfirst was delivered.  

I became increasingly unsettled, as my case was repeatedly “escalated” and never resolved.  I included some inflammatory remarks in letters and phone calls and asked pointed questions about some very obvious things.  

For example: due process is guaranteed in our constitution.  It is fundamental to a free society that people have the right to some kind of hearing, some process, before they can be deprived of something they legally own.  In my case, I’d re-enrolled for coverage in time and subsequently paid for my health insurance through June.  How was it legal to void our contract without notice to the consumer?

As if in answer to this question, I was informed on Good Friday, during this pandemic (not a very good Friday for me) that my insurance had been terminated again, without so much as an email to inform me of this sobering fact, and without any reason given, effective March 31, 2020.

I learned this when I had a call from a doctor I was scheduled to see (over the phone) on Wednesday telling me my insurance came back “inactive.”  When I called Healthfirst to snarlingly enquire, the rep confirmed that they had been instructed to terminate my insurance by the New York State of Health Marketplace, the state’s sole purveyor of Patient Protection and Affordable Care Act health insurance policies.

In the absence of law, those with the power to do so can freely oppress those who are powerless.   If you have no power, you must not be angry about this.  Anger is so bad for your health, your immune system, all of your relationships!

I was told the New York State of Health contacted Healthfirst on March 11, instructing the private corporation to terminate its contract with the patient.  No reason was given.   Any day between March 11 and March 25 would have been an ideal time for either or these entities to inform the patient of the jeopardy he was about to face (no health insurance during a worldwide plague) and the need for immediate action on his part to prevent the loss of the insurance he’d already paid for.  

There was no email, phone call or letter — none from Healthfirst, none from the so-called New York State of Health.   Healthfirst sent me a notice that my ongoing cardiac treatment had been approved through July, an invoice showing that my premiums were paid through June, and numerous instant email reminders that I’d not taken the voluntary customer satisfaction survey after each call.   Not a peep about the insurance cancelled ten days before I found out about it when a doctor’s office alerted me to it.

Had the doctor’s office not called, I’d still be blissfully unaware that my health insurance has been quietly null and void for thirteen days and counting.  Seems there should have been some legal process due before a patient is deprived of healthcare during a pandemic, no?

The well-paid CEO of Healthfirst would be perfectly within her rights to be furious at me, after being subjected to provocative lines like these, no matter how otherwise accurate they might be:

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.

The removal of health insurance during a plague is arguably an excessive punishment for an impolitic expression of something that is well-known: private health insurance corporations have every incentive to cull from their rolls older, low-income patients who cost them far more in medical care than they pay in premiums.   That’s just good business sense, however else one might feel about it.  

Why the New York State of Health intervened a month ago, as I was told by Healthfirst the other day, with no reason given, to terminate the ACA insurance of a customer who had re-enrolled and completed his end of the contract with a private insurance company is a question I will not be able to get an answer to any time soon.   During this terrible plague, everyone is overwhelmed, many mistakes are made, lines for help are very long and it is best to stay calm, even when provoked to great fear and anger.  Particularly if you are powerless in a state ruled by the bottom line.

That said, it would be a wonderful thing for citizens to actually be allowed to know the laws that protect them from arbitrary and capricious decisions with terrifying consequences.  It’s kind of maddening that we are not, if I might be so bold.

 

An unknown consumer law is no law

Under the New York law that administers the troubled, frequently attacked, never amended, industry-drafted Patient Protection and Affordable Care Act, the January termination of my health insurance, by Healthfirst, was overturned by Healthfirst.  

On January 22, 2020 I was informed that my insurance for 2020 had been terminated, without notice, for failure to do something I was also given no notice of.   On January 28, pursuant to my on-line consumer complaint at the New York State Department of Financial Services (where else?)  I had an apologetic call from Healthfirst.  

My insurance had never been terminated, I was told, the supervisor who claimed it had been, and filed the internal appeal I’d lost, had been mistaken when she told me my health insurance had been cancelled.   It had never actually been terminated at all.

Apologies were offered, I beat the poor rep into the ground forcing more and more explicit apologies and admissions out of her.   I paid my premiums through June and lived happily ever after, though I never was able to learn what law had revealed Healthfirst’s “mistake” to it, what law had caused it to overturn an apparently unlawful determination against me.

I have been seeking since to find this law, to cite it by name,  quote its language and set out the requirements for a legal termination of a New York State citizen’s health insurance.  I’d like to help inform my fellow low-income citizens that there are laws in place to protect us from unfair, in fact, illegal, termination of our ACA health insurance and a way to enforce that law and keep our health insurance.   Nobody I have reached in the state government can find the applicable provisions of law for me.  

A law that calls itself the Patient Protection Act (or it used to, before Trump changed the name), while leaving information about key protections unknowable, is useless.  Worse than useless, really, since the legal protection actually exists, only it’s secret — unless some concealed right is accidentally triggered by a lucky individual who files the right hidden complaint.  I will keep searching, apparently it can take a long time to answer certain seemingly straightforward  questions of law and fact.

Just as it will be a while before I can learn what “mistake” resulted in my insurance being irrevocably cancelled again, as I learned yesterday, this time by the government agency that administers the Patient Protection and Affordable Care Act in New York State.  The agency that proudly claims that it is helping all New Yorkers during this public health crisis.

Law, it’s so last century.